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Lee AR, McDermott O, Orrell M. Findings from the Promoting Independence in Dementia App (PRIDE-app) Study a Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework Discussion. J Geriatr Psychiatry Neurol 2024:8919887241246237. [PMID: 38595074 DOI: 10.1177/08919887241246237] [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: 04/11/2024]
Abstract
INTRODUCTION Self-management is pivotal in helping people with their independence and in managing their health conditions more effectively. The PRIDE-app is a novel online intervention, providing support and information for people living with dementia and their families, aimed at increasing self-management and improving quality of life. Knowledge generated will help inform future developments to the app, with the aim of improving its uptake and implementation in services. METHODS A mixed-methods approach incorporating the RE-AIM framework. Recruited 25 people living with dementia, of which 17completed the PRIDE-app intervention over 8 weeks with support from a dementia adviser facilitator. Measures exploring mood, physical well-being, and quality of life were collected at baseline, 3 and 6 months and analysed through modelled analysis. Post-intervention interviews were conducted with participants and facilitators and analysed through thematic analysis. RESULTS Quantitative results did not show significant improvements in participants' scores. Qualitative data showed that the PRIDE-app motivated people to reconnect socially and set individual goals for activities. Participants and facilitators identified areas for improvements to the app interface and delivery format. CONCLUSIONS This study evaluated the PRIDE-app's reach, effectiveness and adoptability in the independence and quality of life of people living with dementia, as well as how it could be implemented and maintained within services. Pre- and post-intervention scores were inconclusive. Interviews provided positive feedback of the app's influence on peoples' activities and mood.
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Affiliation(s)
- Abigail Rebecca Lee
- Department of Mental Health and Clinical Neurosciences, University of Nottingham School of Medicine, Nottingham, UK
| | - Orii McDermott
- Department of Mental Health and Clinical Neurosciences, University of Nottingham School of Medicine, Nottingham, UK
| | - Martin Orrell
- Department of Mental Health and Clinical Neurosciences, University of Nottingham School of Medicine, Nottingham, UK
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Politis A, Vorvolakos T, Kontogianni E, Alexaki M, Georgiou EZE, Aggeletaki E, Gkampra M, Delatola M, Delatolas A, Efkarpidis A, Thanopoulou E, Kostoulas K, Naziri V, Petrou A, Savvopoulou K, Siarkos K, Soldatos RF, Stamos V, Nguyen KH, Leroi I, Kiosses D, Tsimpanis K, Alexopoulos P. Old-age mental telehealth services at primary healthcare centers in low- resource areas in Greece: design, iterative development and single-site pilot study findings. BMC Health Serv Res 2023; 23:626. [PMID: 37312113 DOI: 10.1186/s12913-023-09583-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/19/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Even though communities in low-resource areas across the globe are aging, older adult mental and cognitive health services remain mainly embedded in tertiary- or secondary hospital settings, and thus not easily accessible by older adults living in such communities. Here, the iterative development of INTegRated InterveNtion of pSychogerIatric Care (INTRINSIC) services addressing the mental and cognitive healthcare needs of older adults residing in low-resource areas of Greece is depicted. METHODS INTRINSIC was developed and piloted in three iterative phases: (i) INTRINSIC initial version conceptualization; (ii) A 5-year field testing in Andros island; and (iii) Extending the services. The INTRINSIC initial version relied on a digital platform enabling videoconferencing, a flexible battery of diagnostic tools, pharmacological treatment and psychosocial support and the active involvement of local communities in service shaping. RESULTS Ιn 61% of the 119 participants of the pilot study, new diagnoses of mental and/or neurocognitive disorders were established. INTRINSIC resulted in a significant reduction in the distance travelled and time spent to visit mental and cognitive healthcare services. Participation was prematurely terminated due to dissatisfaction, lack of interest or insight in 13 cases (11%). Based on feedback and gained experiences, a new digital platform, facilitating e-training of healthcare professionals and public awareness raising, and a risk factor surveillance system were created, while INTRINSIC services were extended to incorporate a standardized sensory assessment and the modified problem adaptation therapy. CONCLUSION The INTRINSIC model may be a pragmatic strategy to improve access of older adults with mental and cognitive disorders living in low-resource areas to healthcare services.
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Affiliation(s)
- Antonios Politis
- Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Vasilissis Sophias 72, Athens, 11528, Greece
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry, Johns Hopkins Medical School, 600 N. Wolfe Street Meyer Building, Baltimore, MD, 21287, USA
| | - Theofanis Vorvolakos
- Department of Psychiatry, School of Health Sciences, University General Hospital of Alexandroupolis, Democritus University of Thrace, University Campus, Dragana, Alexandroupolis, 68100, Greece
| | - Evaggelia Kontogianni
- Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Vasilissis Sophias 72, Athens, 11528, Greece
| | - Maria Alexaki
- Primary Healthcare Center of Andros, Chora, Andros, 84500, Greece
| | - Eleni-Zacharoula Eliza Georgiou
- Mental Health Services, University General Hospital of Patras, Department of Medicine, School of Health Sciences, University of Patras, Rion, Patras, 26504, Greece
| | - Eleutheria Aggeletaki
- Nursing Services Department, General Hospital of Syros "Vardakeio and Proio", Geor. Papandreou 2, Ermoupolis, 84100, Greece
| | - Maria Gkampra
- Primary Healthcare Center of Xanthi, Andrea Dimitriou 1, Xanthi, 67133, Greece
| | - Maria Delatola
- Primary Healthcare Center of Tinos, Mark. Krikeli 18, Tinos, 84200, Greece
| | - Antonis Delatolas
- Primary Healthcare Center of Tinos, Mark. Krikeli 18, Tinos, 84200, Greece
| | - Apostolos Efkarpidis
- Nursing Services Department, General Hospital of Syros "Vardakeio and Proio", Geor. Papandreou 2, Ermoupolis, 84100, Greece
| | | | | | - Vassiliki Naziri
- Primary Healthcare Center of Soufli, Soufli Evros, 68400, Greece
| | - Anna Petrou
- Nursing Services Department, General Hospital of Syros "Vardakeio and Proio", Geor. Papandreou 2, Ermoupolis, 84100, Greece
| | | | - Kostas Siarkos
- Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Vasilissis Sophias 72, Athens, 11528, Greece
| | - Rigas Filippos Soldatos
- Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Vasilissis Sophias 72, Athens, 11528, Greece
| | - Vasileios Stamos
- Primary Healthcare Center of Erymanthia, Erymanthia Achaea, 25015, Greece
| | - Kim-Huong Nguyen
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, The University of Dublin, Lloyd Building Trinity College Dublin, Dublin 2, Dublin, Republic of Ireland
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital campus, Woolloongabba, QLD, 4102, Australia
| | - Iracema Leroi
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, The University of Dublin, Lloyd Building Trinity College Dublin, Dublin 2, Dublin, Republic of Ireland
| | - Dimitrios Kiosses
- Cognition, and Psychotherapy Lab, Department of Psychiatry, Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, 315 East 62nd Street, 5th Floor, New York, NY, 10065, USA
| | - Konstantinos Tsimpanis
- Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Panepistimiopolis, Athens, Ilissia, 15784, Greece
| | - Panagiotis Alexopoulos
- Mental Health Services, University General Hospital of Patras, Department of Medicine, School of Health Sciences, University of Patras, Rion, Patras, 26504, Greece.
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, The University of Dublin, Lloyd Building Trinity College Dublin, Dublin 2, Dublin, Republic of Ireland.
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Collins K, Hanna M, Makarski J, Kastner M. Occupational Therapist Led Cognitive Stimulation Therapy: Feasibility of Implementation. Can J Occup Ther 2023; 90:68-78. [PMID: 35903935 DOI: 10.1177/00084174221115284] [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: 11/16/2022]
Abstract
Background. Despite local training opportunities for Cognitive Stimulation Therapy (CST) for occupational therapists, there has been limited evaluation of the feasibility of implementation in Canada. Purpose. This study explored the feasibility of CST delivery by an occupational therapist in an Ontario health care setting and the impact it may have on self-efficacy and hope measures of individuals with dementia. Methods. A mixed-methods experimental pre/post design was used. Survey measures included hope, self-efficacy, feasibility, satisfaction, and individual session evaluation. Semistructured focus groups were held for participants and facilitators. Findings. Quantitative findings are summarized descriptively for the 10 participants. Qualitative findings were grouped into themes: social connectedness, knowledge gained and shared, tailored implementation adjustments, and need for long-term programing. Implications. Occupational therapists are well-positioned to implement CST and should be a part of further research to test the intervention rigorously for applicability within a range of Canadian health care settings.
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Mountain G, Wright J, Cooper CL, Lee E, Sprange K, Beresford-Dent J, Young T, Walters S, Berry K, Dening T, Loban A, Turton E, Thomas BD, Young EL, Thompson BJ, Crawford B, Craig C, Bowie P, Moniz-Cook E, Foster A. An intervention to promote self-management, independence and self-efficacy in people with early-stage dementia: the Journeying through Dementia RCT. Health Technol Assess 2022; 26:1-152. [PMID: 35536231 DOI: 10.3310/khha0861] [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: 11/22/2022] Open
Abstract
BACKGROUND There are few effective interventions for dementia. AIM To determine the clinical effectiveness and cost-effectiveness of an intervention to promote self-management, independence and self-efficacy in people with early-stage dementia. OBJECTIVES To undertake a randomised controlled trial of the Journeying through Dementia intervention compared with usual care, conduct an internal pilot testing feasibility, assess intervention delivery fidelity and undertake a qualitative exploration of participants' experiences. DESIGN A pragmatic two-arm individually randomised trial analysed by intention to treat. PARTICIPANTS A total of 480 people diagnosed with mild dementia, with capacity to make informed decisions, living in the community and not participating in other studies, and 350 supporters whom they identified, from 13 locations in England, took part. INTERVENTION Those randomised to the Journeying through Dementia intervention (n = 241) were invited to take part in 12 weekly facilitated groups and four one-to-one sessions delivered in the community by secondary care staff, in addition to their usual care. The control group (n = 239) received usual care. Usual care included drug treatment, needs assessment and referral to appropriate services. Usual care at each site was recorded. MAIN OUTCOME MEASURES The primary outcome was Dementia-Related Quality of Life score at 8 months post randomisation, with higher scores representing higher quality of life. Secondary outcomes included resource use, psychological well-being, self-management, instrumental activities of daily living and health-related quality of life. RANDOMISATION AND BLINDING Participants were randomised in a 1 : 1 ratio. Staff conducting outcome assessments were blinded. DATA SOURCES Outcome measures were administered in participants' homes at baseline and at 8 and 12 months post randomisation. Interviews were conducted with participants, participating carers and interventionalists. RESULTS The mean Dementia-Related Quality of Life score at 8 months was 93.3 (standard deviation 13.0) in the intervention arm (n = 191) and 91.9 (standard deviation 14.6) in the control arm (n = 197), with a difference in means of 0.9 (95% confidence interval -1.2 to 3.0; p = 0.380) after adjustment for covariates. This effect size (0.9) was less than the 4 points defined as clinically meaningful. For other outcomes, a difference was found only for Diener's Flourishing Scale (adjusted mean difference 1.2, 95% confidence interval 0.1 to 2.3), in favour of the intervention (i.e. in a positive direction). The Journeying through Dementia intervention cost £608 more than usual care (95% confidence interval £105 to £1179) and had negligible difference in quality-adjusted life-years (-0.003, 95% confidence interval -0.044 to 0.038). Therefore, the Journeying through Dementia intervention had a mean incremental cost per quality-adjusted life-year of -£202,857 (95% confidence interval -£534,733 to £483,739); however, there is considerable uncertainty around this. Assessed fidelity was good. Interviewed participants described receiving some benefit and a minority benefited greatly. However, negative aspects were also raised by a minority. Seventeen per cent of participants in the intervention arm and 15% of participants in the control arm experienced at least one serious adverse event. None of the serious adverse events were classified as related to the intervention. LIMITATIONS Study limitations include recruitment of an active population, delivery challenges and limitations of existing outcome measures. CONCLUSIONS The Journeying through Dementia programme is not clinically effective, is unlikely to be cost-effective and cannot be recommended in its existing format. FUTURE WORK Research should focus on the creation of new outcome measures to assess well-being in dementia and on using elements of the intervention, such as enabling enactment in the community. TRIAL REGISTRATION This trial is registered as ISRCTN17993825. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jessica Wright
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy L Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Research Unit, University of Nottingham, Nottingham, UK
| | | | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katherine Berry
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Tom Dening
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amanda Loban
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emily Turton
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Benjamin D Thomas
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma L Young
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Benjamin J Thompson
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Bethany Crawford
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Claire Craig
- Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Peter Bowie
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | | | - Alexis Foster
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Dupuis S, McAiney C, Loiselle L, Hounam B, Mann J, Wiersma EC. Use of participatory action research approach to develop a self-management resource for persons living with dementia. DEMENTIA 2021; 20:2393-2411. [PMID: 33631971 PMCID: PMC8564262 DOI: 10.1177/1471301221997281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article describes the use of a participatory action research (PAR) approach to developing a self-management resource for persons living with dementia and care partners. Despite growing evidence that persons with dementia are able to contribute in meaningful ways to decision-making about their care and life preferences, few opportunities exist for them to participate in the design of resources and services meant for them. There is also a need to support the self-management of persons living with dementia with the provision of accurate, high quality, user-friendly information. The Living Well with Dementia resource was developed through a partnership with persons with dementia, family members, Alzheimer Society representatives, primary care providers, and researchers. The methods used in the development of this resource are outlined in six steps employed in this process, from establishment of a PAR team to final resource creation. Informed by a whole systems approach, the resource brings together essential components of self-management into a comprehensive system of care and support for living. It empowers users to be active participants in the application of new knowledge to their lives. Better self-management has important implications for access to health care and quality of life for persons with dementia and care partners.
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Affiliation(s)
- Sherry Dupuis
- Department of Recreation and Leisure Studies and Partnerships in Dementia Care Alliance, 8430University of Waterloo, Ontario, Canada
| | - Carrie McAiney
- School of Public Health and Health Systems and Partnerships in Dementia Care Alliance, 8430University of Waterloo, Ontario, Canada
| | - Lisa Loiselle
- Murray Alzheimer Research and Education Program, 8430University of Waterloo, Ontario, Canada
| | - Brenda Hounam
- Partner living with dementia of the Murray Alzheimer Research and Education Program, 8430University of Waterloo, Ontario, Canada
| | - Jim Mann
- Partner living with dementia of the Murray Alzheimer Research and Education Program, 8430University of Waterloo, Ontario, Canada
| | - Elaine C Wiersma
- Department of Health Sciences and the Centre for Education and Research on Aging & Health, Lakehead University, Ontario, Canada
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Skov SS, Nielsen MBD, Krølner RF, Øksnebjerg L, Rønbøl Lauridsen SM. A multicomponent psychosocial intervention among people with early-stage dementia involving physical exercise, cognitive stimulation therapy, psychoeducation and counselling: Results from a mixed-methods study. DEMENTIA 2021; 21:316-334. [PMID: 34416131 DOI: 10.1177/14713012211040683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is increasing awareness of the benefits of both physical and psychosocial interventions to empower and benefit people with dementia and their caregivers. However, the potential additional benefits of combining physical and psychosocial interventions have only been sparsely explored. The aim of this pilot study was to investigate the acceptability and potential impact of a multicomponent intervention comprising physical exercise, cognitive stimulation therapy (CST), psychoeducation and counselling for people with early-stage dementia. DESIGN A 15-week multicomponent group-based intervention was offered to people with early-stage dementia in Denmark (N = 44). A mixed-methods design combining interviews, observations, tests of cognitive and physical functioning and an interviewer-assisted questionnaire on quality of life was applied to (1) investigate acceptability of the intervention, including whether people with dementia and their caregivers found the intervention meaningful and (2) to explore and assess changes in participants' physical and cognitive functioning and quality of life. The study was conducted between June 2018 and August 2019. RESULTS The pilot study demonstrated that the multicomponent intervention was acceptable for people with early-stage dementia and their caregivers. Test results did not show significant changes in measures of participants' physical and cognitive functioning or quality of life. However, qualitative data revealed that participants perceived the intervention as meaningful and found that it had a positive influence on their physical and social well-being. In addition, interaction and support from peers and staff members was considered important and rewarding. CONCLUSION This multicomponent intervention constitutes a meaningful and beneficial activity for people with early-stage dementia and their caregivers. It provides an opportunity to engage in social interactions with peers and experience professional support. The study also underlines the importance of providing prolonged and sustainable interventions for people with dementia to maintain personal and social benefits.
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Killen A, Flynn D, O'Brien N, Taylor JP. The feasibility and acceptability of a psychosocial intervention to support people with dementia with Lewy bodies and family care partners. DEMENTIA 2021; 21:77-93. [PMID: 34171967 PMCID: PMC8721619 DOI: 10.1177/14713012211028501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives Psychosocial support for people with dementia with Lewy bodies (DLB) and family care partners is frequently lacking, despite the need expressed by those with lived experience. Our objective was to examine the feasibility and acceptability of an intervention designed to build coping capability. Design The design was non-randomised with all participants receiving the intervention. Setting The setting was a Memory Assessment and Management Service in the Northeast of England. Participants Participants comprised 19 dyads consisting of a person with DLB and a family care partner. Intervention The intervention was group-based, with weekly sessions attended for up to four successive weeks. It was informed by Social Cognitive Theory. Measurements Data were collected on recruitment, attendance and attrition, self-efficacy, mood, stress and participant experience. Results Recruitment was achieved with minimal attrition and three successive groups were delivered. Care partners felt more in control and able to cope in at least 3 of 13 areas with 73% feeling this way in eight or more areas. Three themes were identified from post-intervention interviews: people like us, outcomes from being a group member and intervention design. Conclusions A DLB-specific group intervention is acceptable to people with DLB and family care partners, and recruitment is feasible within a specialist service. Participation may enhance understanding of this condition and reduce social isolation. It may improve care partners’ coping capability particularly if targeted towards those with low prior understanding of DLB and more stress. Means of evaluating outcomes for people with DLB need further development.
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Affiliation(s)
- Alison Killen
- Translational and Clinical Research Institute, 5994Newcastle University, Newcastle upon Tyne, UK
| | - Darren Flynn
- School of Health and Life Sciences, 5462Teesside University, Middlesbrough, UK
| | - Nicola O'Brien
- Department of Psychology, 5995Northumbria University, Newcastle, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, 5994Newcastle University, Newcastle upon Tyne, UK
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Chester H, Beresford R, Clarkson P, Entwistle C, Gillan V, Hughes J, Orrell M, Pitts R, Russell I, Symonds E, Challis D. The Dementia Early Stage Cognitive Aids New Trial (DESCANT) intervention: A goal attainment scaling approach to promote self-management. Int J Geriatr Psychiatry 2021; 36:784-793. [PMID: 33271639 DOI: 10.1002/gps.5479] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/16/2020] [Accepted: 11/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study investigated goals identified by people with dementia and their carers to promote the self-management of symptoms and abilities; measured achievement using goal attainment scaling (GAS); and explored the reflections of Dementia Support Practitioners (DSPs) facilitating it. METHODS AND DESIGN Within this pragmatic randomised trial, DSPs gave memory aids, training and support to people with mild to moderate dementia and their carers at home. Data were collected across seven NHS Trusts in England and Wales (2016-2018) and abstracted from intervention records and semi-structured interviews with DSPs delivering the intervention, supplemented by a subset of the trial dataset. Measures were created to permit quantification and descriptive analysis and interview data thematically analysed. A GAS measure for this intervention in this client group was derived. RESULTS Engagement was high across the 117 participants and 293 goals were identified. These reflected individual circumstances and needs and enabled classification and assessment of their attainment. Seventeen goal types were identified across six domains: self-care, household tasks, daily occupation, orientation, communication, and well-being and safety. On average participants achieved nominally significant improvement regarding the specified goals of 1.4 with standard deviation of 0.6. Five interviews suggested that DSPs' experiences of goal setting were also positive. CONCLUSIONS GAS is useful for assessing psychosocial interventions for people with early-stage dementia. It has a utility in identifying goals, promoting self-management and providing a personalised outcome measure. There is a strong case for exploring whether these clear benefits translate to other interventions in other populations in other places.
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Affiliation(s)
- Helen Chester
- School of Medicine, Institute of Mental Health, The University of Nottingham, Nottingham, UK
| | - Rebecca Beresford
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Paul Clarkson
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Charlotte Entwistle
- Department of Psychology, Fylde College, Lancaster University, Lancaster, UK
| | - Vincent Gillan
- Faculty of Biology, Medicine and Health, Formerly of School of Health Sciences, The University of Manchester, Manchester, UK
| | - Jane Hughes
- School of Medicine, Institute of Mental Health, The University of Nottingham, Nottingham, UK
| | - Martin Orrell
- School of Medicine, Institute of Mental Health, The University of Nottingham, Nottingham, UK
| | - Rosa Pitts
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ian Russell
- Swansea Trials Unit, Medical School, Swansea University, Swansea, Wales, UK
| | - Eileen Symonds
- School of Medicine, Institute of Mental Health, The University of Nottingham, Nottingham, UK
| | - David Challis
- School of Medicine, Institute of Mental Health, The University of Nottingham, Nottingham, UK
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Dixon E, Piper AM, Lazar A. "Taking care of myself as long as I can": How People with Dementia Configure Self-Management Systems. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2021; 2021:656. [PMID: 34250524 PMCID: PMC8265518 DOI: 10.1145/3411764.3445225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Self-management research in HCI has addressed a variety of conditions. Yet, this literature has largely focused on neurotypical populations and chronic conditions that can be managed, leaving open questions of what self-management might look like for populations with progressive cognitive impairment. Grounded in interviews with seventeen technology savvy people with mild to moderate dementia, our analysis reveals their use of technological and social resources as part of the work of self-management. We detail how participants design self-management systems to enable desired futures, function well in their social world, and maintain control. Our discussion broadens the notion of self-management to include future-oriented, sociotechnical, self-determinate design. We advocate for expanding the way technologists, designers, and HCI scholars view people with mild to moderate dementia to recognize them as inventive creators and capable actors in self-management.
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Affiliation(s)
- Emma Dixon
- University of Maryland, College Park, Maryland, USA
| | | | - Amanda Lazar
- University of Maryland, College Park, Maryland, USA
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Beentjes KM, Neal DP, Kerkhof YJF, Broeder C, Moeridjan ZDJ, Ettema TP, Pelkmans W, Muller MM, Graff MJL, Dröes RM. Impact of the FindMyApps program on people with mild cognitive impairment or dementia and their caregivers; an exploratory pilot randomised controlled trial. Disabil Rehabil Assist Technol 2020; 18:253-265. [PMID: 33245000 DOI: 10.1080/17483107.2020.1842918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE FindMyApps is a web-based selection-tool and errorless learning training program to help people with mild dementia/Mild Cognitive Impairment (MCI) and caregivers find user-friendly apps. In preparation of a definitive trial, the impact and feasibility of the FindMyApps intervention on self-management and engagement in meaningful activities, including social participation, was explored. MATERIALS AND METHODS An exploratory pilot randomised controlled trial (trial registration approval number: NL7210) with pre/post measurements was conducted with community-dwelling people with mild dementia/MCI and their caregivers (n = 59) in the Netherlands. Dyads in the experimental group (n = 28) received training to use the tablet and FindMyApps, and the errorless learning method was taught to their caregivers. Control group dyads (n = 31) received a tablet (without FindMyApps), instructions on tablet-use and links to dementia-friendly apps. Validated instruments were used to assess person with dementia's self-management, meaningful activities and social participation, caregiver's sense of competence and both their quality of life. RESULTS AND CONCLUSIONS No statistical significant group differences on the outcomes were found. Small to moderate effect-sizes in favour of the FindMyApps group were found for self-management and social participation. Caregivers tended to have more positive care experiences. Subgroup analyses showed that people older than 70 benefitted more from FindMyApps regarding self-management and higher educated people benefitted more regarding social participation. FindMyApps is feasible for the target group and may have potential to improve self-management and social participation. For a future definitive effectiveness trial a larger sample size is recommended, as well as taking into account the possible impact of education and age.IMPLICATIONS FOR REHABILITATIONThe FindMyApps program is feasible for people with dementia/MCI and may have potential to improve their self-management and social participation.Informal caregivers may develop a more positive care experience when utilizing FindMyApps to find suitable apps for self-management and social participation for the person with dementia/MCI.
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Affiliation(s)
- Kim M Beentjes
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - David P Neal
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Yvonne J F Kerkhof
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Centre for Nursing Research, Sector Health Care, Saxion University of Applied Sciences, Deventer/Enschede, the Netherlands
| | - Caroline Broeder
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Faculty of Science, Universiteit van Amsterdam, Amsterdam, the Netherlands
| | - Zaïnah D J Moeridjan
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Faculty of Behavior and Movement Sciences, Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Teake P Ettema
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Wiesje Pelkmans
- Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Majon M Muller
- Department of Internal Medicine, Section Geriatric Medicine, Center of Geriatric Medicine (COGA), Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Maud J L Graff
- Department of Rehabilitation and Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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11
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Self-management and social participation in community-dwelling people with mild dementia: a review of measuring instruments. Int Psychogeriatr 2019; 31:1267-1285. [PMID: 30724149 DOI: 10.1017/s1041610218001709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In order to evaluate interventions promoting social health in people with dementia it is essential to have reliable and valid measures. The present review aims to provide an overview of available instruments for the assessment of two domains of social health in community-dwelling people with mild dementia, i.e., the ability to manage life with some degree of independence (self-management) and participation in social activities. METHODS An electronic search was conducted in the following databases: PubMed, CINAHL, and PsycINFO. Characteristics of the instruments, feasibility and psychometric properties of the instruments included are reported on. RESULTS We identified eight instruments measuring aspects of self-management and three instruments measuring social participation. Validity and reliability of self-management instruments varied between moderate and good. Little information was found on the psychometric properties of the instruments for social participation. In general, feasibility and responsiveness data regarding application in community-dwelling people with dementia were scarce for both types of instruments. CONCLUSIONS Future research into assessment tools for social health should focus on the development of instruments for self-management that also cover the areas of coping with and adapting to the emotional consequences of the disease; instruments for social participation covering the involvement in social interactions that are experienced as meaningful by the person; and on the psychometric properties and responsiveness of instruments. More attention should also be given to the feasibility (ease of use) of these instruments for people with mild dementia, professionals, and researchers.
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12
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Joddrell P, Astell A. Implementing Accessibility Settings in Touchscreen Apps for People Living with Dementia. Gerontology 2019; 65:560-570. [DOI: 10.1159/000498885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/13/2019] [Indexed: 11/19/2022] Open
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13
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Mendes A. Avoiding hospital readmission of a person with dementia. ACTA ACUST UNITED AC 2019; 28:263. [PMID: 30811226 DOI: 10.12968/bjon.2019.28.4.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
People with dementia can be confused or distressed by hospital admission, which can then impact on their physical health. Aysha Mendes considers ways to reduce distress and enhance wellbeing.
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14
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Bielsten T, Lasrado R, Keady J, Kullberg A, Hellström I. Living Life and Doing Things Together: Collaborative Research With Couples Where One Partner Has a Diagnosis of Dementia. QUALITATIVE HEALTH RESEARCH 2018; 28:1719-1734. [PMID: 30033851 DOI: 10.1177/1049732318786944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The aim of this study is to identify relevant content for a self-management guide by using the outcomes of previous research in combination with knowledge and experiences from couples where one partner has a diagnosis of dementia. The study was carried out in three phases: (a) literature search of previous research related to well-being and couplehood in dementia; (b) interviews with couples with dementia based on the findings of the literature search; and (c) further authentication of the findings within expert groups of people with dementia and carers. For analysis of data, we used a hybrid approach of thematic analysis with combined deductive and inductive approaches. The findings of this study indicated that the four main themes "Home and Neighborhood," "Meaningful Activities and Relationships," "Approach and Empowerment," and "Couplehood" with related subthemes could be appropriate targets for a self-management guide for couples where one partner has a diagnosis of dementia.
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Affiliation(s)
| | - Reena Lasrado
- 2 University of Manchester, Manchester, United Kingdom
| | - John Keady
- 2 University of Manchester, Manchester, United Kingdom
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15
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Bunn F, Goodman C, Jones PR, Russell B, Trivedi D, Sinclair A, Bayer A, Rait G, Rycroft-Malone J, Burton C. Managing diabetes in people with dementia: a realist review. Health Technol Assess 2018; 21:1-140. [PMID: 29235986 DOI: 10.3310/hta21750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Dementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes. OBJECTIVES To identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research. DESIGN Realist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders. PARTICIPANTS Twenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference. DATA SOURCES The following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing - UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA). RESULTS We included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context-mechanism-outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia. LIMITATIONS There is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven. CONCLUSIONS This review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes. STUDY REGISTRATION This study is registered as PROSPERO CRD42015020625. FUNDING The NIHR HTA programme.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, UK
| | - Antony Bayer
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Chris Burton
- School of Healthcare Sciences, Bangor University, Bangor, UK
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16
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Huis In Het Veld JG, Verkaik R, van Meijel B, Verkade PJ, Werkman W, Hertogh CMPM, Francke AL. Self-Management Support and eHealth When Managing Changes in Behavior and Mood of a Relative With Dementia: An Asynchronous Online Focus Group Study of Family Caregivers' Needs. Res Gerontol Nurs 2018; 11:151-159. [PMID: 29498746 DOI: 10.3928/19404921-20180216-01] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/02/2018] [Indexed: 11/20/2022]
Abstract
The current article discusses how and by whom family caregivers want to be supported in self-management when managing changes in behavior and mood of relatives with dementia and whether family caregivers consider eHealth a useful tool for self-management support. Four asynchronous online focus groups were held with 32 family caregivers of individuals with dementia. Transcripts of the online focus groups were analyzed using qualitative thematic analysis. Family caregivers need support from professionals or peers in the form of (a) information about dementia and its symptoms, (b) tips and advice on managing changes in behavior and mood, (c) opportunities to discuss experiences and feelings, and (d) appreciation and acknowledgement of caregiving. The opinions of family caregivers about self-management support through eHealth were also reported. Findings suggest a personal approach is essential to self-management support for family caregivers managing changes in behavior and mood of relatives with dementia. In addition, self-management support can be provided to some extent through eHealth, but this medium cannot replace personal contacts entirely. [Res Gerontol Nurs. 2018; 11(3):151-159.].
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17
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Cheffey J, Hill L, Roberts G, Marlow R. Supporting self-management in early dementia: a contribution towards ‘living well’? ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.112.011023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThere has been increasing interest in how to assist people to ‘live well’ with advancing and incurable conditions late into life. This article considers the progress made in mental health services for adults of working age which promote active involvement in their care and how these principles can be applied to older adults with dementia. The concept of ‘recovery’ and its applicability to dementia care are discussed. The Wellness Recovery Action Plan (WRAP) and how it could be translated and modified to the needs of people with dementia are explored. This is especially important in light of the UK National Dementia Strategy, which emphasises early diagnosis and intervention to promote improved care and quality of life.
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18
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Bielsten T, Hellström I. An extended review of couple-centred interventions in dementia: Exploring the what and why - Part B. DEMENTIA 2017; 18:2450-2473. [PMID: 29105499 DOI: 10.1177/1471301217737653] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This scoping review is an extended version of a narrative review of couple-centred interventions in dementia shared in part A and the previous publication in this edition. The rationale for expanding study A emerged through the fact that most dyadic interventions have samples consisting of a majority of couples. The exclusion of interventions with samples of mixed relationships in part A therefore contributed to a narrow picture of joint dyadic interventions for couples in which one partner has a dementia. The aim of this second review is to explore the ‘what’ (types of interventions) and the ‘why’ (objectives and outcome measures) of dyadic interventions in which sample consists of a majority of couples/spouses and in which people with dementia and caregivers jointly participate. Method A five-step framework for scoping reviews guided the procedure. Searches were performed in Academic Search Premier, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science. Results Twenty-one studies with various types of psychosocial interventions were included. The main outcome measure for people with dementia was related to cognitive function, respectively caregiver burden and depression for caregivers. Conclusions The findings of this extended review of joint dyadic interventions in dementia are in line with the findings of part A regarding the negative approach of outcomes, lack of a genuine dyadic approach, lack of tailored support, neglect of interpersonal issues and the overlook of the views of people with dementia. This review also recognises that measures of caregiver burden, as well as relationship quality should be considered in samples of mixed relationships due to the different significance of burden and relationship quality for a spouse as opposed to an adult child or friend.
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Affiliation(s)
- Therése Bielsten
- Department of Social and Welfare Studies, Linkopings universitet Institutionen for samhalls- och valfardsstudier, Linköping University, Sweden
| | - Ingrid Hellström
- Department of Social and Welfare Studies, Linkopings universitet Institutionen for samhalls- och valfardsstudier, Linköping University, Sweden; Department of Health Care Science, Ersta Sköndal Bräcke University College, Sweden
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19
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Bunn F, Goodman C, Reece Jones P, Russell B, Trivedi D, Sinclair A, Bayer A, Rait G, Rycroft-Malone J, Burton C. What works for whom in the management of diabetes in people living with dementia: a realist review. BMC Med 2017; 15:141. [PMID: 28750628 PMCID: PMC5532771 DOI: 10.1186/s12916-017-0909-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/04/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD. METHODS This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories and their validation with a purposive sample of stakeholders. Twenty-six stakeholders - user/patient representatives, dementia care providers, clinicians specialising in diabetes or dementia and researchers - took part in interviews, and 24 participated in a consensus conference. RESULTS We included 89 papers. Ten focused on PLWD and diabetes, and the remainder related to people with either dementia, diabetes or other long-term conditions. We identified six context-mechanism-outcome configurations which provide an explanatory account of how interventions might work to improve the management of diabetes in PLWD. This includes embedding positive attitudes towards PLWD, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. An overarching contingency emerged concerning the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. CONCLUSIONS Evidence highlighted the need for personalised care, continuity and family-centred approaches, although there was limited evidence that this happens routinely. This review suggests there is a need for a flexible service model that prioritises quality of life, independence and patient and carer priorities. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to their needs. TRIAL REGISTRATION PROSPERO, CRD42015020625. Registered on 18 May 2015.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | | | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, LU1 3UA, UK
| | - Antony Bayer
- Division of Population Medicine, Cardiff University, Cardiff, Wales, CF10 3AT, LL57 2EF, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | | | - Christopher Burton
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
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20
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Escalante MAL, Tsekleves E, Bingley A, Gradinar A. ‘Ageing Playfully’: a story of forgetting and remembering. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/24735132.2017.1295529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maria A. Luján Escalante
- The Creative Exchange Hub, Lancaster Institute for the Contemporary arts (LICA), Lancaster University, Lancaster, UK
| | | | - Amanda Bingley
- Faculty of Health & Medicine, Division of Health Research, Lancaster University, Lancaster, UK
| | - Adrian Gradinar
- The Creative Exchange Hub, Lancaster Institute for the Contemporary arts (LICA), Lancaster University, Lancaster, UK
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21
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Better self-management and meaningful activities thanks to tablets? Development of a person-centered program to support people with mild dementia and their carers through use of hand-held touch screen devices. Int Psychogeriatr 2016; 28:1917-1929. [PMID: 27425002 DOI: 10.1017/s1041610216001071] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To offer good support to people with dementia and their carers in an aging and Internet society the deployment of hand-held touch screen devices, better known as tablets, and its applications (apps) can be viable and desirable. However, at the moment it is not clear which apps are usable for supporting people with dementia in daily life. Also, little is known about how people with dementia can be coached to learn to use a tablet and its apps. METHODS A person-centered program, with tools and training, will be developed that aims to support people with mild dementia and their (in)formal carers in how to use the tablet for self-management and meaningful activities. The program will be developed in accordance with the Medical Research Council's (MRC) framework for developing and evaluating complex interventions and the study will cover the following phases: a preclinical or theoretical (0) phase; a modeling phase (I) and the exploratory trial phase (II). The users (people with dementia and their carers) will be involved intensively during all these phases, by means of individual interviews, workshops, focus groups, and case studies. DISCUSSION The iterative process inherent to this framework makes it possible to develop a user-oriented intervention, in this case a person-centered program, for the use of tablets in dementia care. Preparatory work will be done to perform a methodologically sound randomized controlled trial (RCT) in the near future, which aims to investigate the contribution of this person-centered program for tablet use to the quality of life of people with dementia and their carers.
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22
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Wiersma EC, O’Connor DL, Loiselle L, Hickman K, Heibein B, Hounam B, Mann J. Creating space for citizenship: The impact of group structure on validating the voices of people with dementia. DEMENTIA 2016; 15:414-33. [DOI: 10.1177/1471301216642339] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recently, there has been increasing attention given to finding ways to help people diagnosed with dementia ‘live well’ with their condition. Frequently however, the attention has been placed on the family care partner as the foundation for creating a context that supports the person with dementia to live well. A recent participatory action research (PAR) study highlighted the importance of beginning to challenge some of the assumptions around how best to include family, especially within a context of supporting citizenship. Three advisory groups consisting of 20 people with dementia, 13 care partners, and three service providers, were set up in three locations across Canada to help develop a self-management program for people with dementia. The hubs met monthly for up to two years. One of the topics that emerged as extremely important to consider in the structuring of the program revolved around whether or not these groups should be segregated to include only people with dementia. A thematic analysis of these ongoing discussions coalesced around four inter-related themes: creating safe spaces; maintaining voice and being heard; managing the balancing act; and the importance of solidarity. Underpinning these discussions was the fifth theme, recognition that ‘ one size doesn’t fit all’. Overall an important finding was that the presence of family care-partners could have unintended consequences in relation to creating the space for active citizenship to occur in small groups of people with dementia although it could also offer some opportunities. The involvement of care partners in groups with people with dementia is clearly one that is complex without an obvious answer and dependent on a variety of factors to inform a solution, which can and should be questioned and revisited.
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Affiliation(s)
- Elaine C Wiersma
- Centre for Education and Research on Aging & Health, Lakehead University, Thunder Bay, Ontario, Canada
| | - Deborah L O’Connor
- Centre for Research on Personhood in Dementia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Loiselle
- Murray Alzheimer Research and Education Program, University of Waterloo, Waterloo, Ontario, Canada
| | - Kathy Hickman
- Alzheimer Society of Ontario, Toronto, Ontario, Canada
| | | | | | - Jim Mann
- Vancouver, British Columbia, Canada
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23
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Laakkonen ML, Kautiainen H, Hölttä E, Savikko N, Tilvis RS, Strandberg TE, Pitkälä KH. Effects of Self-Management Groups for People with Dementia and Their Spouses--Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:752-60. [PMID: 27060101 DOI: 10.1111/jgs.14055] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the effect of self-management group rehabilitation for persons with dementia (PwD) and their spouses on their health-related quality of life (HRQoL), the cognition of the PwD, and the costs of health and social services. DESIGN A randomized controlled trial. SETTING Primary care and memory clinics in the Helsinki metropolitan area, Finland. PARTICIPANTS PwD (N = 136) and their spouses (N = 136). INTERVENTION Couples were randomized to usual care or eight-session self-management groups for PwD and concurrently for their spouses. Sessions aim to enhance self-efficacy and problem-solving skills and to provide peer support. MEASUREMENTS The primary outcome measures were the HRQoL of PwD (measured using a generic, comprehensive (15-dimensional), self-administered instrument (15D)) and spouses (measured using the RAND-36) and the spousal Sense of Competence Questionnaire (SCQ). Secondary outcome measures were PwD cognition (Verbal Fluency (VF), Clock Drawing Test (CDT)) and costs of health and social services during 24 months. RESULTS At 3 months, the spouse physical component of the RAND-36 improved (mean change 1.0, 95% confidence interval (CI) = -0.5 to 2.4) for those undergoing the intervention and worsened for controls (mean change -2.0, 95% CI = -3.5 to -0.4) (P = .006 adjusted for age, sex, baseline value of the physical component of the RAND-36). There were no differences between the groups on the mental component of the RAND-36, the SCQ, or the 15D. At 9 months, PwD change in VF was -0.38 (95% CI = -1.03 to 0.27) in intervention group and -1.60 (95% CI = -2.26 to -0.94) for controls (P = .011 adjusted for age, sex, baseline MMSE score). CDT changes were similar to VF changes. Differences in incremental costs between the groups was -436 € per person per year (95% CI = -4,986 to 4,115) for PwD (P = .35 adjusted for age, CDR) and -896 € per person per year (95% CI = -3,657 to 1,864) for spouses (P = .51 adjusted for PwD age, CDR). CONCLUSIONS The intervention had beneficial effects on the HRQoL of spouses and the cognitive function of PwD without increasing total costs. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12611001173987.
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Affiliation(s)
- Marja-Liisa Laakkonen
- Geriatric Clinic, Department of Social Services and Health Care, Laakso Hospital, Helsinki, Finland.,Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
| | - Eeva Hölttä
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland.,Geriatric Psychiatric Clinics, Department of Social Services and Health Care, Laakso Hospital, Helsinki, Finland
| | - Niina Savikko
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland.,Department of Home Care, Espoo, Finland
| | - Reijo S Tilvis
- Department of General Internal Medicine and Geriatrics, University of Helsinki, Helsinki, Finland.,General Internal Medicine, Helsinki University Central Hospital, Helsinki, Finland.,Geriatrics Clinics, Helsinki University Central Hospital, Helsinki, Finland
| | - Timo E Strandberg
- Department of General Internal Medicine and Geriatrics, University of Helsinki, Helsinki, Finland.,General Internal Medicine, Helsinki University Central Hospital, Helsinki, Finland.,Geriatrics Clinics, Helsinki University Central Hospital, Helsinki, Finland.,Division of Geriatrics, Institute of Health Sciences, University of Oulu, Oulu, Finland.,Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
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Elliott M, Gardner P. The role of music in the lives of older adults with dementia ageing in place: A scoping review. DEMENTIA 2016; 17:199-213. [DOI: 10.1177/1471301216639424] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Melanie Elliott
- Faculty of Applied Health Sciences, Brock University, Canada
| | - Paula Gardner
- Faculty of Applied Health Sciences, Brock University, Canada
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25
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Verkaik R, van Antwerpen-Hoogenraad P, de Veer A, Francke A, Huis In Het Veld J. Self-management-support in dementia care: A mixed methods study among nursing staff. DEMENTIA 2016; 16:1032-1044. [PMID: 26908547 DOI: 10.1177/1471301216632416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Self-management in patients and family caregivers confronted with dementia is not self-evident. Self-management skills may be limited because of the progressive cognitive decline of the patient and because family caregivers are often also very aged. Self-management support by nursing staff is therefore of paramount importance. Objectives To gain insight into how nursing staff perceive their self-management support tasks, and how they put them into practice. Research questions are: 'What are the opinions and experiences of Dutch nursing staff working in home care or residential elderly care regarding self-management support for people with dementia and their family caregivers?' and 'Do nursing staff feel sufficiently trained and skilled for self-management support?'. Methods A mixed methods approach was used, combining cross-sectional quantitative survey data from 206 Dutch nursing professionals with qualitative interviews among 12 nursing staff working in home care or residential elderly care in The Netherlands. Results Nursing staff working in home care experienced self-management support of people with dementia as a part of their job and as an attractive task. They consider 'helping people with dementia to maintain control over their lives by involving them in decisions in daily care' the essence of self-management support. Nursing staff saw family caregivers as their main partners in providing self-management support to the patient. They were less aware that family caregivers themselves might also need self-management support. Nursing staff often felt insufficiently trained to give adequate self-management support. RN's and CNA's did not differ in their opinions, experiences and training needs. Conclusions Nursing staff in home care do consider self-management support an important and attractive task in dementia care. Their skills for providing self-management support to patients with dementia and family caregivers need improvement. Recommendations Nursing staff need sufficient training to enable the proper provision of self-management support for people with dementia. More attention should also be given to the support of self-management for family caregivers.
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Affiliation(s)
- Renate Verkaik
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | | | - Anke de Veer
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Anneke Francke
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands; VUmc/EMGO+ Institute, Amsterdam, the Netherlands
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Toms GR, Quinn C, Anderson DE, Clare L. Help yourself: perspectives on self-management from people with dementia and their caregivers. QUALITATIVE HEALTH RESEARCH 2015; 25:87-98. [PMID: 25192761 DOI: 10.1177/1049732314549604] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Self-management interventions are increasingly offered to people with chronic health conditions. However, there has been limited exploration of how applicable such an approach is in early stage dementia. In this study we explored the views of people with dementia and family caregivers on the use of self-management in dementia. We conducted semistructured interviews with 13 people with early stage dementia and 11 caregivers. We analyzed transcripts using thematic analysis. We found eight themes in the analysis, and they indicated that self-management occurs in the context of peoples' family and social relationships as well as relationships with professional services. Six of the themes involved barriers to and facilitators of self-management. It is evident from these findings that people with dementia and caregivers use self-management techniques. Their use of such techniques could be enhanced by the development of interventions designed to help people with dementia to develop their self-management skills.
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Quinn C, Anderson D, Toms G, Whitaker R, Edwards RT, Jones C, Clare L. Self-management in early-stage dementia: a pilot randomised controlled trial of the efficacy and cost-effectiveness of a self-management group intervention (the SMART study). Trials 2014; 15:74. [PMID: 24606601 PMCID: PMC3974022 DOI: 10.1186/1745-6215-15-74] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The possibility of living well with a long-term condition has been identified as centrally relevant to the needs of people living with dementia. Growing numbers of people with early-stage dementia are contributing accounts that emphasise the benefits of actively engaging in managing the condition. Self-management interventions share the common objectives of educating about the condition, optimising well-being, enhancing control over the situation and enabling people to take more responsibility for managing the condition. Benefits of such an approach can include improved knowledge, self-efficacy, health status, and better performance of self-management behaviours. However, there is only preliminary evidence that people with early-stage dementia can benefit from such interventions. METHODS This feasibility study involves the development of a self-management group intervention for people with early-stage Alzheimer's disease, vascular dementia or mixed Alzheimer's and vascular dementia. This study is a single-site pilot randomised-controlled trial. Forty-two people with early stage dementia, each with a caregiver (family member/friend), will be randomised to either the self-management group intervention or to treatment as usual.The self-management group intervention will involve eight weekly sessions, each lasting 90 minutes, held at a memory clinic in North Wales. All participants will be re-assessed three and six months post-randomisation. This study is intended to supply an early evaluation of the self-management intervention so that a full scale trial may be powered from the best available evidence. It will assess the feasibility of the intervention, the study design and the recruitment strategies. It will estimate the parameters and confidence intervals for the research questions of interest. The primary outcome of interest is the self-efficacy score of the person with dementia at three months post-randomisation. Secondary outcomes for the person with dementia are self-efficacy at six months post-randomisation and cognitive ability, mood and well-being at three and six months post-randomisation. Secondary outcomes for caregivers are their distress and stress at three and six months post-randomisation. The cost-effectiveness of the intervention will also be examined. DISCUSSION This study will provide preliminary information about the feasibility, efficacy and cost-effectiveness of a self-management group intervention for people in the early stages of dementia. TRIAL REGISTRATION Current Controlled Trials, ISRCTN02023181.
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Affiliation(s)
- Catherine Quinn
- School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK
| | | | - Gill Toms
- School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK
| | - Rhiannon Whitaker
- North Wales Organisation for Randomised Trials in Health, Y Wern, Bangor University, The Normal Site, Holyhead Road, Gwynedd LL57 2PZ, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Dean Street, Gwynedd LL57 1UT, UK
| | - Carys Jones
- Centre for Health Economics and Medicines Evaluation, Bangor University, Dean Street, Gwynedd LL57 1UT, UK
| | - Linda Clare
- School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK
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Singh P, Hussain R, Khan A, Irwin L, Foskey R. Dementia care: intersecting informal family care and formal care systems. J Aging Res 2014; 2014:486521. [PMID: 24701350 PMCID: PMC3950589 DOI: 10.1155/2014/486521] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/06/2014] [Indexed: 12/04/2022] Open
Abstract
Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions related to ageing. This paper is based on a qualitative study undertaken in the Australian state of Queensland and explores issues of access to and use of formal services in dementia care from the perspective of the informal family carers. It identifies three critical points at which changes in policy and practice in the formal care system could improve the capability of informal carers to continue to care for their family member with dementia: when symptoms first become apparent and a diagnosis is sought; when the condition of the person with dementia changes resulting in a change to their support needs; and when the burden of informal care being experienced by the carer is so great that some form of transition appears to be immanent in the care arrangement.
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Affiliation(s)
- Prabhjot Singh
- Disability Services, Queensland Department of Communities, Child Safety and Disability Services, Brisbane, QLD 4001, Australia
| | - Rafat Hussain
- University of New England, Armidale, NSW, Australia
- School of Rural Medicine, University of New England, Armidale, NSW 2351, Australia
| | - Adeel Khan
- University of New England, Armidale, NSW, Australia
| | - Lyn Irwin
- Aged Care Standards and Accreditation Agency Ltd., Sydney, NSW 2124, Australia
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Laakkonen ML, Savikko N, Hölttä E, Tilvis R, Strandberg T, Kautiainen H, Pitkälä K. Self-management groups for people with dementia and their spousal caregivers. A randomized, controlled trial. Baseline findings and feasibility. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stockwell-Smith G, Moyle W, Kellett U, Brodaty H. Community practitioner involvement in collaborative research. DEMENTIA 2013; 14:450-67. [DOI: 10.1177/1471301213498760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper focuses on the benefits and limitations of collaborative research in community-based service settings explored through the implementation of a psychosocial intervention. The study aimed to establish the effectiveness of working with dementia dyads (person with dementia and family caregiver) in the early stages of dementia and to recruit and train an existing practitioner workforce to deliver a psychosocial intervention designed to assist dementia dyads to manage the consequences of dementia. Seven intervention staff participated in post-intervention semi-structured interviews. Whilst staff recruitment and retention proved challenging the degree to which staff demonstrated the required communication skills and competence was an important component in dyad acceptability of the intervention. Participatory factors, collaborative development, selective recruitment, focused training and ongoing specialist support, can assist the implementation of practice-based research. However, intervention staff participation and therefore intervention delivery can be hampered by workplace culture and workforce demands.
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Affiliation(s)
| | - Wendy Moyle
- Centre for Health Practice Innovation, Griffith University, Australia
| | - Ursula Kellett
- Centre for Health Practice Innovation, Griffith University, Australia
| | - Henry Brodaty
- Dementia Collaborative Research Centre – Assessment and Better Care, University of New South Wales, Australia
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Martin F, Turner A, Wallace LM, Stanley D, Jesuthasan J, Bradbury N. Qualitative evaluation of a self-management intervention for people in the early stage of dementia. DEMENTIA 2013; 14:418-35. [PMID: 24339106 DOI: 10.1177/1471301213498387] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Self-management programs are effective for people living with chronic illnesses. However, there has been little research addressing self-management for people with dementia in the early stages. This study presents a qualitative evaluation of the experiences of attending a novel self-management program and initial process evaluation. The program was designed with and for people with dementia. It addresses: (a) relationship with family, (b) maintenance of an active lifestyle, (c) psychological well-being, (d) techniques to cope with memory changes and (e) information about dementia. Six participants with early stage dementia completed the intervention that was co-delivered by lay and clinical professional tutors. Participants and tutors attended focus group and interviews at the end of the program to explore their perceptions of the intervention. These were audio-recorded, transcribed verbatim and analysed thematically. Participants reported enjoyment and benefits from the intervention. This was despite some reporting concerns relating to their memory difficulties. The program's flexible nature, focus on strengths and the opportunity to spend time with other people living with dementia were particularly well received. Participants and tutors outlined areas for further improvement. The program was feasible and its flexible delivery appeared to facilitate participant benefit. Emphasis should be placed on maintaining activity and relationships, improving positive well-being and social interaction during the program. Memory of the pleasant experience and strengths focus was evidenced, which may impact positively on quality of life. The results highlight the usefulness and acceptability of self-management for people with early stage dementia and provide initial support for the program's structure and content.
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Affiliation(s)
- Faith Martin
- Applied Research Centre in Health and Lifestyle Interventions, Whitefriars Building, Coventry University, Coventry, UK
| | - Andrew Turner
- Applied Research Centre in Health and Lifestyle Interventions, Whitefriars Building, Coventry University, Coventry, UK
| | - Louise M Wallace
- Applied Research Centre in Health and Lifestyle Interventions, Whitefriars Building, Coventry University, Coventry, UK
| | | | - Jana Jesuthasan
- Applied Research Centre in Health and Lifestyle Interventions, Whitefriars Building, Coventry University, Coventry, UK
| | - Nicola Bradbury
- Mental Health Services for Older People, Juniper Centre, Birmingham
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Abstract
OBJECTIVES First, to use participative research methods to obtain views from people with dementia and carers about their experiences and the interventions that they consider can assist in facilitating independence and quality of life post diagnosis. Second, to use these views to identify priority topics for a potential self-management programme. Third, to explore the relevance of the identified topics with a consultation group of people with dementia and their carers, thus informing the creation of a draft self-management programme. METHOD A series of individual and dyad interviews were conducted with people with dementia and family carers to explore their experiences post diagnosis and obtain views of how quality life can be maintained while living with dementia. A further group of people with dementia and carers then met over six successive weeks to explore and provide feedback on the topic areas generated out of the initial interviews and add to the content. RESULTS Data generated from the individual interviews identified a number of themes for a potential self-management group which were then validated through consultation. Optimum modes of delivery of a self-management programme were also indicated. CONCLUSIONS A draft programme has been constructed building upon the framework of identified priorities. The process and outputs from the consultation also indicated the significant ramifications of such a programme for services.
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Affiliation(s)
- Gail A Mountain
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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Laakkonen ML, Hölttä EH, Savikko N, Strandberg TE, Suominen M, Pitkälä KH. Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial. Trials 2012; 13:133. [PMID: 22871107 PMCID: PMC3492198 DOI: 10.1186/1745-6215-13-133] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 07/17/2012] [Indexed: 11/22/2022] Open
Abstract
Background After diagnosis of a dementing illness, patients and their spouses have many concerns related to the disease and their future. This often leads to poor psychological well-being and reduced health-related quality of life (HRQoL) of the family. Support for self-management skills has been proven to be an effective method to improve prognosis of asthma, heart failure and osteoarthritis. However, self-management interventions have not been studied in dementia. Therefore, our aim was to examine, in an objective-oriented group intervention, the efficacy of self-management support program (SMP) on the HRQoL of dementia patients and their spousal caregivers as well as on the sense of competence and psychological well-being of caregivers. Methods During the years 2011 to 12, 160 dementia patients and their spouses will be recruited from memory clinics and randomized into two arms: 80 patients for group-based SMP sessions including topics selected by the participants, 80 patients will serve as controls in usual community care. Sessions may include topics on dementia, community services, active lifestyle and prevention for cognitive decline, spousal relationship, future planning and emotional well-being. The patients and spouses will have their separate group sessions (ten participants per group) once a week for eight weeks. Main outcome measures will be patients’ HRQoL (15D) and spousal caregivers’ HRQoL (RAND-36), and sense of competence (SCQ). Secondary measures will be caregivers’ psychological well-being (GHQ-12) and coping resources, patients’ depression, cognition and signs of frailty. Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two-year follow-up. Discussion This is a ‘proof-of-concept’ study to explore the efficacy of group support for self-management skills among dementia families. It will also provide data on cost-effectiveness of the intervention. Trial registration ACTRN12611001173987
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Affiliation(s)
- Marja-Liisa Laakkonen
- Department of General Practice, University of Helsinki, PO Box 20, Helsinki 00014, Finland.
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Abstracts. Br J Occup Ther 2012. [DOI: 10.1177/03080226120758s101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
With the changing health care environment, prevalence of chronic health conditions, and burgeoning challenges of health literacy, obesity, and homelessness, self-management support provides an opportunity for clinicians to enhance effectiveness and, at the same time, to engage patients to participate in managing their own personal care. This article reviews the differences between patient education and self-management and describes easy-to-use strategies that foster patient self-management and can be used by health care providers in the medical setting. It also highlights the importance of linking patients to nonmedical programs and services in the community.
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Affiliation(s)
- Patrick T McGowan
- Centre on Aging, University of Victoria, Victoria, British Columbia, Canada.
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Hochgraeber I, Riesner C, Schoppmann S. The experience of people with dementia in a social care group: Case study. DEMENTIA 2012; 12:751-68. [DOI: 10.1177/1471301212444300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Germany hourly care for people with dementia and relief for family caregivers are often delivered through social care groups. The existing literature describes these groups from the perspective of professionals or family caregivers, with little involvement of people with dementia. This qualitative study is the first step in exploring the experiences of people with dementia in social care groups. Five persons suffering from dementia in one group were interviewed and additionally observed with DCM in three group sessions. The interview transcripts were coded open and axial according to Grounded Theory. The DCM data was analysed descriptive. The main phenomena in the interviews are ‘familiar community’ and ‘personal meaning’. The DCM results show that people with lower cognitive function are excluded from most activities, whereas more staff attention causes better well-being. To create a ‘familiar community’ in a social care group, staff skills and knowledge are required.
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Affiliation(s)
- Iris Hochgraeber
- German Center for Neurodegenerative Diseases (DZNE), Standort Witten, Germany
| | - Christine Riesner
- German Center for Neurodegenerative Diseases (DZNE), Standort Witten, Germany
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Abstract
BACKGROUND Human rights and citizenship are concepts widely used in health and social care literature. However, they are applied less frequently and less rigorously in dementia care. This paper briefly presents these concepts before exploring how they have been applied to dementia care policy and practice. We highlight areas of dementia care where human rights can be violated and citizenship can be denied. We suggest reasons why people with dementia can be denied their human and civil rights and discuss how such concepts provide a way to address cultural and practice change in dementia care. AIMS AND OBJECTIVES To demonstrate how these concepts can be used to challenge and improve dementia care nursing. CONCLUSIONS This paper contributes to emerging discussion about dementia care nursing by challenging conventional ways of understanding dementia and the care practices that result. Taking a rights-based approach allows nurses to examine inequity in services and address poor practice. IMPLICATIONS FOR PRACTICE Looking at dementia through the lenses of citizenship and human rights provides a way to broaden the scope of contemporary dementia care nursing, to enable nurses to challenge inequity and to develop and improve the direct nursing care offered to people with dementia.
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Affiliation(s)
- Fiona Kelly
- School of Applied Social Science, University of Stirling, Stirling, UK.
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Martin F, Turner A, Wallace LM, Choudhry K, Bradbury N. Perceived barriers to self-management for people with dementia in the early stages. DEMENTIA 2012; 12:481-93. [PMID: 24336956 DOI: 10.1177/1471301211434677] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
People with dementia in the early stages currently experience a care gap, which self-management may address. We explore perceived barriers to self-management. Using a systematic approach (logic mapping), 19 participants (people with dementia, carers, health care professionals and charity representatives) described self-management barriers facing people living with dementia. Thematic content analysis revealed six main themes: the lived experience of dementia, diagnosis, role of carer/family, impact of health care professionals, organisation of health services and societal views. People with dementia were seen as passive recipients of care, unable to self-manage owing to the impact of dementia on cognitive abilities. The need for interventions that are largely emotion focused, encourage activity maintenance and improve quality of life are described. Barriers to self-management exist at multiple levels, suggesting a whole-systems approach is required.
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Affiliation(s)
- Faith Martin
- Applied Research Centre in Health and Lifestyle Interventions, Coventry University, UK
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Irving K, Lakeman R. Reconciling mental health recovery with screening and early intervention in dementia care. Int J Ment Health Nurs 2010; 19:402-8. [PMID: 21054726 DOI: 10.1111/j.1447-0349.2010.00703.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
If early intervention in dementia care is to be enhanced, it is important to have a critical debate over how this should be realized. In this paper, we offer a synthesis of two approaches to care: mental health recovery and person-centred care, and apply them to early-stage dementia care. 'Person-centred care' has become a catchphrase for good dementia care. However, many people have not experienced improvements in care, and other lynch pin concepts, such as 'mental health recovery', might have utility in driving reform. The similarities and differences between the two approaches are drawn out, and the difficulties of using the word 'recovery' when discussing a degenerative disease are highlighted. The implications of this discussion for early intervention are discussed. It could be seen that the two bodies of knowledge have much to offer each other, despite initial dissonance with the label of recovery in dementia care.
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Affiliation(s)
- Kate Irving
- School of Nursing, Dublin City University, Dublin, Ireland.
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Joosten-Weyn Banningh LWA, Prins JB, Vernooij-Dassen MJFJ, Wijnen HH, Olde Rikkert MGM, Kessels RPC. Group therapy for patients with mild cognitive impairment and their significant others: results of a waiting-list controlled trial. Gerontology 2010; 57:444-54. [PMID: 20664181 DOI: 10.1159/000315933] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 05/31/2010] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients with mild cognitive impairment (MCI) have to deal with an uncertain prognosis and also face a multitude of memory-related problems and psychosocial consequences. A newly developed group programme proved to be feasible, however, it needed confirmation by a controlled study. AIM This controlled study evaluates this group therapy for MCI patients aimed to help them accept and manage the memory problems and the psychosocial consequences. The programme combines elements from psychoeducation, cognitive rehabilitation and cognitive-behavioural therapy. PATIENTS AND METHODS Ninety-three MCI patients received treatment, with 30 patients being first assigned to a waiting list, thus serving as their own control group. Pre- and post-treatment acceptance and helplessness were assessed using subscales of the Illness Cognition Questionnaire, while distress and general well-being were gauged with the Geriatric Depression Scale and subscales of the RAND-36. RESULTS Linear mixed model analyses showed that, relative to the controls, acceptance had increased more in the intervention group compared to the waiting-list period (p = 0.034). Distress and general well-being showed no changes. Treatment responders demonstrating a clinically significant effect on acceptance and two of three secondary outcome measures had higher baseline levels of helplessness and fewer self-reported memory complaints in daily life than patients who did not improve. CONCLUSION The intervention helped the patients deal better with their uncertain future in that they were overall better able to accept their condition, with especially the female patients showing a decrease in helplessness cognitions, although the effects were relatively small.
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Affiliation(s)
- Liesbeth W A Joosten-Weyn Banningh
- Department of Medical Psychology, Alzheimer Centre Nijmegen, Radboud University Nijmegen Medical Centre, The Netherlands. l.joosten @ mps.umcn.nl
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Robinson L, Iliffe S, Brayne C, Goodman C, Rait G, Manthorpe J, Ashley P, Moniz-Cook E. Primary care and dementia: 2. Long-term care at home: psychosocial interventions, information provision, carer support and case management. Int J Geriatr Psychiatry 2010; 25:657-64. [PMID: 19946862 DOI: 10.1002/gps.2405] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To write a narrative review of the role of primary care physicians in the long-term care of people with dementia living at home, with a focus on psychosocial interventions, the provision of information and carer support, behavioural and psychological symptoms and case management. METHODS The systematic review carried out for the NICE/SCIE Guidelines was updated from January 2006, Cochrane Reviews were identified and other publications found by consultations with experts. RESULTS In primary care, the long-term care of people with dementia living at home can be structured around several key themes: reframing dementia with a focus on a social model of disability; active use of information sources; supporting carers (caregivers); the management of behavioural and psychological symptoms and a structured case management approach. CONCLUSIONS Caring for people with dementia in primary care demands the same systematic approach as the management of other long-term conditions. The systematic follow-up of both people with dementia and their carers should be integrated into primary care. Reframing dementia, with an emphasis on abilities retained may allow people with dementia and their families to develop more effective coping strategies; an increase in skill mix within primary care is required to deliver this and may also improve the management of behavioural problems. The potential benefits of person-centred interventions, like advance care planning, and alternative models of service delivery, such as a structured, collaborative care approach which promotes integrated case management within primary care, require further evaluation.
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Affiliation(s)
- Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
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White EB, Montgomery P, McShane R. Electronic Tracking for People with Dementia Who Get Lost outside the Home: A Study of the Experience of Familial Carers. Br J Occup Ther 2010. [DOI: 10.4276/030802210x12706313443901] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose: The study aimed to elicit a description of GPS (global positioning system) tracking use in the care of people with dementia in domestic settings and to generate hypotheses about impact. Procedures: Users were recruited through a commercial provider. Qualitative interviews with 10 carers were completed to generate an in-depth description of how the devices were used and the perceived impact. A questionnaire was administered to ascertain sample characteristics. Findings: Most carers preferred to use tracking as a back-up to other strategies of management, particularly supervision by a carer and locked doors. In cases where the carers perceived the risk of harm from getting lost to be low, tracking was used to preserve the independence of the person with dementia. The carers reported that tracking gave them reassurance and also enhanced the sense of independence both for themselves and for the person with dementia. The poor reliability of the device was identified as a substantial limitation. Conclusion: Larger studies are needed to assess the safety and clinical value of GPS tracking. These should explore the views of people with dementia. Assessment tools are needed to assess suitability. Occupational therapy can play a pivotal role in this process of intervention design, assessment and evaluation.
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Affiliation(s)
| | | | - Rupert McShane
- Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust, Oxford
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Glasgow NJ, Jeon Y, Kraus SG, Pearce‐Brown CL. Chronic disease self‐management support: the way forward for Australia. Med J Aust 2008; 189:S14-6. [DOI: 10.5694/j.1326-5377.2008.tb02203.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 09/14/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Nicholas J Glasgow
- Medicine and Health Sciences, Australian National University, Canberra, ACT
| | - Yun‐Hee Jeon
- Australian Primary Health Care Research Institute, Australian National University, Canberra, ACT
| | - Stefan G Kraus
- Australian Primary Health Care Research Institute, Australian National University, Canberra, ACT
| | - Carmen L Pearce‐Brown
- Australian Primary Health Care Research Institute, Australian National University, Canberra, ACT
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