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Burrell LV, Rostad HM, Wentzel-Larsen T, Raknes Sogstad MK. Allocation of Adult Day Care Services to Different User Groups: A Register-Based Cross-Sectional Study. Health Serv Insights 2024; 17:11786329241231003. [PMID: 38332842 PMCID: PMC10851712 DOI: 10.1177/11786329241231003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
The international policy of active ageing emphasises activities and social relations for long-term care recipients, for example through adult day care. Knowledge about who are allocated such services is, however, sparse. We aimed to investigate characteristics that contribute to determine allocation of adult day care for care recipients with and without dementia. This study selected all 250 687 individuals who received long-term care services on 31 December 2019 from the Norwegian Register for Primary Health Care. We added municipal level data from the Municipality-State-Reporting register and a national survey. Multilevel analyses comparing allocation of adult day care services to other services found that municipal clustering was around 20%. Care recipients who lived alone had higher odds of receiving adult day care, while the odds of receiving adult day care decreased as age increased. Disability level and gender were also significantly associated with allocation of adult day care, but in different directions for different user groups. As the unrestricted revenues of municipalities increased, the odds of allocating adult day care to people without dementia decreased. Other municipality characteristics did not significantly impact the allocation of adult day care. In conclusion, individual characteristics were more influential in allocation of adult day care than municipality characteristics, and the results uncovered clear differences between care recipients with and without dementia.
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Affiliation(s)
- Lisa Victoria Burrell
- Centre for Care Research, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Hanne Marie Rostad
- Centre for Care Research, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Tore Wentzel-Larsen
- Centre for Care Research, Norwegian University of Science and Technology, Gjøvik, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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Rostad HM, Skinner MS, Wentzel-Larsen T, Hellesø R, Sogstad MKR. Modes and models of care delivery in municipal long-term care services: a cross-sectional study from Norway. BMC Health Serv Res 2023; 23:813. [PMID: 37525166 PMCID: PMC10388513 DOI: 10.1186/s12913-023-09750-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/25/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Numerous forces drive the evolution and need for transformation of long-term care services. Decision-makers across the globe are searching for models to redesign long-term care to become more responsive to changing health and care needs. Yet, knowledge of different care models unfolding in the long-term care service landscape is limited. The objective of this article is twofold: 1) to identify and characterise models of care in Norwegian municipal long-term care services based on four different modes of service delivery: Specialised municipal services, Assistive technology, Planning and coordination, and Health Promotion and Activity, and 2) to analyse whether the identified care models vary with regard to municipal characteristics, more specifically 'population size' and 'income'. METHODS We adopted a cross-sectional approach and used data from a web-based survey conducted in 2019 to identify and characterize models of care in Norwegian long-term care services, based on four modes of service delivery. The questionnaire was developed through a comprehensive review of national healthcare policy documents and previous research and amended in collaboration with a user panel. A set of questions from the questionnaire were used to create four modes of service delivery. Hierarchical cluster analysis was used to cluster the municipalities based on the mean scores of the modes to identify care models. RESULTS In total, 277 municipalities (response rate 66%) completed the survey. The four modes made it possible to identify four care models that differ on the level of Specialised municipal services, Assistive technology, Planning and coordination, and Health Promotion and Activity. Additionally, the models differed regarding municipal population size (p < 0.001) and income (p = 0.006). CONCLUSIONS We put forward a theoretical description of the variety of ways long-term care services are provided, offering a way of simplifying complex information which can assist care providers and policymakers in analysing and monitoring their own service provision and making informed decisions. This is important to the development of services for current and future care needs.
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Affiliation(s)
- Hanne Marie Rostad
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
| | | | - Tore Wentzel-Larsen
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Centre for Child and Adolescent Mental Health (RBUP), Southern and Eastern Norway, Oslo, Norway
- Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Ragnhild Hellesø
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Burrell LV, Rostad HM, Wentzel-Larsen T, Skinner MS, Sogstad MKR. The influence of individual and municipality characteristics on allocation of long-term care services: a register-based cross-sectional study. BMC Health Serv Res 2023; 23:801. [PMID: 37501173 PMCID: PMC10373409 DOI: 10.1186/s12913-023-09641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 06/03/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Variation in service allocation between municipalities may arise as a result of prioritisation. Both individual and societal characteristics determine service allocation, but previous literature has often investigated these factors separately. The present study aims to map variation in allocation of long-term care services and investigate the extent to which service allocation is associated with characteristics related to the individual care recipient and the municipality. METHODS This cross-sectional study used register data from the Norwegian Registry for Primary Health Care on all 250 687 individuals receiving municipal health and care services in Norway on 31 December 2019. These individual level data were paired with municipal level data from the Municipality-State-Reporting register and information on the care models in Norwegian long-term care services, derived from a nationwide survey. Multilevel analyses were used to identify individual and municipal factors that were associated with allocation of home care, practical assistance and long-term stay in institutions. RESULTS In total, 164 634 people received home care services and 97 380 received practical assistance per 31 December 2019. Furthermore, 64 404 received both types of home-based services and 31 342 people had a long-term stay in an institution. Increased disability was strongly associated with being allocated more hours of home care and practical assistance, as well as allocation of a long-term institutional stay. The amount of home care and practical assistance declined with increasing age, but the odds of institutional stay increased with age. Care recipients living alone received more home-based services, and women had higher odds of a long-term institutional stay. Significant associations between the proportion of elderly in nursing homes and allocation of a long-term institutional stay and more practical assistance emerged. Other associations with municipalities' structural characteristics and care service models were weak. CONCLUSIONS The influence of individual characteristics outweighed the contribution of municipality characteristics, and the results point to a limited influence of municipality characteristics on allocation of long-term care services.
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Affiliation(s)
- Lisa Victoria Burrell
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
| | - Hanne Marie Rostad
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Tore Wentzel-Larsen
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1‑3, Oslo, 0484, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1, Oslo, 0484, Norway
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Rostad HM, Burrell LV, Skinner MS, Hellesø R, Sogstad MKR. Quality of Municipal Long-Term Care in Different Models of Care: A Cross-Sectional Study From Norway. Health Serv Insights 2023; 16:11786329231185537. [PMID: 37475731 PMCID: PMC10354822 DOI: 10.1177/11786329231185537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
The quality of care remains a critical concern for health systems around the globe, especially in an era of unprecedented financial challenges and rising demands. Previous research indicates large variation in several indicators of quality in the long-term care setting, highlighting the need for further investigation into the factors contributing to such disparities. As different ways of delivering long-term care services likely affect quality of care, the objectives of our study is to investigate (1) variation in structure, process and outcome quality between municipalities, and (2) to what extent variation in quality is associated with municipal models of care and structural characteristics. The study had a cross-sectional approach and we utilized data on the municipal level from 3 sources: (1) a survey for models of care (2) Statistics Norway for municipal structural characteristics and (3) the National Health Care Quality Indicator System. Descriptive statistics showed that the Norwegian long-term care sector performs better (measured as percentage or probability) on structure (85.53) and outcome (84.86) quality than process (37.85) quality. Hierarchical linear regressions indicated that municipal structural characteristics and model of care had very limited effect on the quality of long-term care. A deeper understanding of variation in service quality may be found at the micro level in healthcare workers' day-to-day practice.
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Affiliation(s)
- Hanne Marie Rostad
- Center for Care Research East, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Lisa Victoria Burrell
- Center for Care Research East, Norwegian University of Science and Technology, Gjøvik, Norway
| | | | - Ragnhild Hellesø
- Center for Care Research East, Norwegian University of Science and Technology, Gjøvik, Norway
- Department of Public Health Science, University of Oslo, Oslo, Norway
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Fossbråten L, Renolen Å, Rostad HM. IVARETATT? – En pårørendeundersøkelse. TFO 2022. [DOI: 10.18261/tfo.8.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rostad HM, Skinner MS, Larsen TW, Sogstad MKR. Sammenheng i kommunale helse- og omsorgstjenester – hvor mye flytter eldre mellom ulike tilbud i kommunen? TFO 2021. [DOI: 10.18261/issn.2387-5984-2021-02-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rostad HM, Stokke R. Integrating Welfare Technology in Long-term Care Services: Nationwide Cross-sectional Survey Study. J Med Internet Res 2021; 23:e22316. [PMID: 34398791 PMCID: PMC8406104 DOI: 10.2196/22316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/19/2020] [Accepted: 05/24/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Welfare technologies are often described as a solution to the increasing pressure on primary health care services. However, despite initiating welfare technology projects in the health care sector and different government incentives, research indicates that it is difficult to integrate welfare technology innovations in a complex and varying setting, such as long-term care. OBJECTIVE We aim to describe the types of welfare technology and the extent to which welfare technology is provided in long-term care (ie, nursing homes and home care services); examine whether the extent of welfare technology provision differs on the basis of municipal characteristics (ie, population size, centrality, the proportion of older inhabitants, and income); and identify how local governments (ie, municipalities) describe their efforts toward integrating welfare technologies in long-term care. METHODS Quantitative and qualitative data about welfare technology from a larger cross-sectional survey about the provision of long-term care services in Norwegian municipalities were combined with registry data. Representatives of 422 Norwegian municipalities were invited to participate in the survey. Frequencies were used to describe the distribution of the types and extent of welfare technologies, whereas the Fisher exact test and Kruskal-Wallis one-way analysis of variance were used to determine the association between the extent of welfare technology and municipal characteristics. Free-form text data were analyzed using thematic analysis. RESULTS A total of 277 municipalities were surveyed. Technology for safety was the most widespread type of welfare technology, whereas technology for social contact was the least prevalent. Two-thirds of the sample (183/277, 66.1%) in nursing home and (197/277, 71.1%) in home care services reported providing one or two different types of welfare technology. There was a statistically significant association between the extent of welfare technology and population size (in both nursing homes and home care services: P=.01), centrality (nursing homes: P=.01; home care services: P<.001), and municipal income (nursing homes: P=.02; home care services: P<.001). The extent of welfare technology was not associated with the proportion of older adults. The municipalities described being in a piloting phase and committing to future investment in welfare technology. Monetary resources were allocated, competency development among staff was initiated, and the municipalities were concerned about establishing collaborations within and between municipalities. Home care services seem to have a more person-centered approach in their efforts toward integrating welfare technologies, whereas nursing homes seem to have a more technology-centered approach. CONCLUSIONS Many municipalities provide welfare technologies; however, their extent is limited and varies according to municipal characteristics. Municipal practices still seem dominated by piloting, and welfare technologies are not fully integrated into long-term care services. Innovation with welfare technology appears top-down and is influenced by national policy but also reflects creating a window of opportunity through the organization of municipal efforts toward integrating welfare technology through, for example, collaborations and committing personnel and financial resources.
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Affiliation(s)
- Hanne Marie Rostad
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Randi Stokke
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
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Holmen H, Riiser K, Løyland B, Sandbekken IH, Almendingen K, Andenæs R, Bjørnnes AK, Fagerlund BH, Früh EA, Helseth S, Kvarme LG, Leegaard M, Misvær N, Pallesen S, Rasalingam A, Ravn I, Ribu L, Rostad HM, Sparboe-Nilsen B, Sæterstrand TM, Torbjørnsen A, Utne I, Valeberg BT, Valla L, Winger A, Grov EK. Students' top 10 priorities of research uncertainties on students' sleep: a pragmatic James Lind Alliance approach. BMJ Open 2021; 11:e043697. [PMID: 33500290 PMCID: PMC7839855 DOI: 10.1136/bmjopen-2020-043697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Inspired by the James Lind Alliance (JLA) user involvement approach, the aim of the present study was to identify the top 10 uncertainties for sleep research raised by students in higher education, and to discuss our experiences with adapting the JLA method to a student population. DESIGN The study design is a pragmatic JLA approach, including a priority setting partnership within the field of sleep, collection of sleep-related research uncertainties as reported by students in higher education, sorting of the uncertainties and a final identification of the top 10 uncertainties through collaborative work between researchers, students, stakeholders and experts in the field. Uncertainties were collected using a one-question online survey: 'as a student, which question(s) do you consider to be important with regards to sleep?'. A variety of approaches were applied to promote the survey to the students, including social media, radio, the university website, stands in university cafeterias and a sleep stunt. NVivo V.12 was used to code and sort the questions. SETTING A higher education institution in Norway. PARTICIPANTS 555 students. RESULTS The data collection provided 608 uncertainties, and the following prioritised top 10: (1) screen time, (2) stress, (3) educational achievements, (4) social relations, (5) mental health, (6) physical activity, (7) indoor environment, (8) substance abuse, (9) shift work and (10) sleep quality. Despite successful data collection, we found sleep to be a broad topic, and defining specific questions throughout the sorting and verification process proved difficult. CONCLUSIONS We identified the prioritised top 10 research uncertainties as reported by students in higher education, ranking screen time first. However, the process was time and resource consuming. The research uncertainties addressed by the students showed great diversity, characterised by heterogeneity and a lack of specificity, making verification of the uncertainties challenging.
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Affiliation(s)
- Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kirsti Riiser
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ida Hellum Sandbekken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kari Almendingen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Randi Andenæs
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Bettina Holmberg Fagerlund
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Elena Albertini Früh
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Sølvi Helseth
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Marit Leegaard
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Nina Misvær
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ståle Pallesen
- University of Bergen Faculty of Social Sciences, Bergen, Norway
| | - Anurajee Rasalingam
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ingrid Ravn
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Lis Ribu
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Hanne Marie Rostad
- Centre for Care Research, Norwegian University of Science and Technology, Gjovik Campus, Gjovik, Norway
| | - Bente Sparboe-Nilsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Hospitality, Culinary Arts and Meal Science, Örebro Universitet, Campus Grythyttan, Grythyttan, Sweden
| | - Torill Margaret Sæterstrand
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Berit Taraldsen Valeberg
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Lisbeth Valla
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Rostad HM, Skinner MS, Hellesø R, Sogstad MKR. Towards specialised and differentiated long-term care services: a cross-sectional study. BMC Health Serv Res 2020; 20:793. [PMID: 32843038 PMCID: PMC7448320 DOI: 10.1186/s12913-020-05647-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/12/2020] [Indexed: 11/11/2022] Open
Abstract
Background Numerous forces drive the evolution and need for transformation of long-term care services. During the previous decade, primary health care has assumed increased responsibility for developing and providing care services, but there is still limited knowledge about how European care service systems are evolving to address new tasks and patients. Based on data from Norwegian municipalities, this study aims to (1) describe the availability of specialised services in Norwegian nursing homes and home care services and (2) analyse whether structural factors, like population size and/or centrality, are associated with the availability of specialised services in nursing homes and home care. Methods This is a cross-sectional study of survey data. An online survey was designed specifically for this study. Its questions were developed from a comprehensive review of the literature and in partnership with a user panel. One representative from all of Norway’s 422 municipalities were invited to answer the survey from February to April 2019. In total, 277 municipalities completed the survey (response rate 66%). Chi-square analysis and Fisher’s exact test were used to test the associations between different categorical variables. Results Specialised care services were highly prevalent. For example, there were nursing home units specialising in dementia care (89%) and rehabilitation (81%) and home care teams for dementia care (79%) and reablement (76%). Approximately two-thirds of our sample were categorised as having high availability of specialisation in nursing home and home care services. The larger, more central municipalities had higher availability of specialisation compared to medium-sized and small, less central municipalities. Conclusions Our study indicates that a majority of nursing homes and home care services provide specialised and differentiated services that serve patient groups of different ages and diagnoses. Municipalities’ population size and centrality are associated with availability of specialised services in nursing homes and home care services.
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Affiliation(s)
- Hanne Marie Rostad
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
| | | | - Ragnhild Hellesø
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
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Bethell J, Commisso E, Rostad HM, Puts M, Babineau J, Grinbergs-Saull A, Wighton MB, Hammel J, Doyle E, Nadeau S, McGilton KS. Patient engagement in research related to dementia: A scoping review. Dementia (London) 2018; 17:944-975. [PMID: 30373460 DOI: 10.1177/1471301218789292] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Patient 'engagement' or 'involvement' in health research broadly refers to including people with lived experience (i.e. individuals with personal experience of a health issue and their friends, family and caregivers or carers) in the research process. Although previous reviews have systematically summarized approaches to patient engagement in research, it is unclear whether and how engagement activities have been implemented or adapted for research related to dementia. We conducted a scoping review to describe the extent and nature of patient engagement approaches that have been used to involve persons with dementia and their care partners in research. We then summarized the reported barriers, enablers, and impacts of this engagement. Fifty-four research articles were included in the review and almost all were published after 2010. Persons with dementia and their care partners have been engaged in diverse phases of the research process. The majority of engagement involved both persons with dementia and care partners. Barriers and enablers to engagement included those identified for general patient engagement in research, but some more specific to engaging persons with dementia and their care partners were also reported. Very few studies assessed the impact of patient engagement. While the arguments for patient engagement in research are compelling, research to demonstrate the impact - on the research process and outcomes as well as on persons with dementia, care partners, researchers, research institutions and society - is still needed.
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Affiliation(s)
- Jennifer Bethell
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Elana Commisso
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | | | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Jessica Babineau
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Anna Grinbergs-Saull
- Alzheimer's Society, UK; NIHR Clinical Research Network South London, Guy's Hospital, London, UK
| | | | - John Hammel
- Ontario Dementia Advisory Group, London, Canada
| | - Elizabeth Doyle
- Geriatric Medicine, Nova Scotia Health Authority / Dalhousie University, Halifax, Canada; Canadian Consortium on Neurodegeneration in Aging
| | - Sacha Nadeau
- Geriatric Medicine, Nova Scotia Health Authority / Dalhousie University, Halifax, Canada; Canadian Consortium on Neurodegeneration in Aging
| | - Katherine S McGilton
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Canadian Consortium on Neurodegeneration in Aging
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Rostad HM, Utne I, Grov EK, Småstuen MC, Puts M, Halvorsrud L. The impact of a pain assessment intervention on pain score and analgesic use in older nursing home residents with severe dementia: A cluster randomised controlled trial. Int J Nurs Stud 2018; 84:52-60. [PMID: 29763832 DOI: 10.1016/j.ijnurstu.2018.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/08/2018] [Accepted: 04/26/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pain is highly prevalent in older adults, especially those in institutional settings such as nursing homes. The presence of dementia may increase the risk of underdiagnosed and undertreated pain. Pain assessment tools are not regularly used in clinical practice, however, there are indications that the regular use of pain assessments tools may influence the recognition of pain by nursing staff and thereby affect pain management. OBJECTIVES To assess whether regular pain assessment using a pain assessment tool is associated with changes in i) pain scores and ii) analgesic use in nursing home residents with severe dementia. DESIGN Cluster-randomised controlled trial. SETTING The study was conducted in 16 nursing homes in four counties in Norway. PARTICIPANTS A total of 112 nursing home residents aged 65 years and older with dementia who lacked the capacity for self-reporting pain or were non-verbal. METHODS The experimental group were regularly assessed pain with a standardised pain scale (the Doloplus-2) twice a week for a 12-week intervention period. The control group received usual care. The primary outcome was pain score measured with the Doloplus-2, and the secondary outcome was analgesic use (oral morphine equivalents and milligram/day paracetamol). Data on the outcomes were collected at baseline and at the end of week 12. The nursing staff in both the experimental and the control groups received training to collect the data. Linear mixed models were used to assess possible between-group difference over time. RESULTS No overall effect of regular pain assessment was found on pain score or analgesic use. The mean score of Doloplus-2 and analgesic use remained unchanged and above the established cut-off in both groups. CONCLUSION The current intervention did not change analgesic use or pain score compared with the control condition. However, there is not sufficient evidence to conclude that regular pain assessment using a pain assessment tool is not clinically relevant. Furthermore, our results indicated that pain continued to be inadequately treated in nursing home residents with severe dementia. Therefore, further research on how standardised pain assessment can be used to support effective pain management in this population is needed.
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Affiliation(s)
| | - Inger Utne
- OsloMet - Oslo Metropolitan University, Oslo, Norway
| | | | | | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Rostad HM, Utne I, Grov EK, Puts M, Halvorsrud L. Measurement properties, feasibility and clinical utility of the Doloplus-2 pain scale in older adults with cognitive impairment: a systematic review. BMC Geriatr 2017; 17:257. [PMID: 29096611 PMCID: PMC5667437 DOI: 10.1186/s12877-017-0643-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Doloplus-2 is a pain assessment scale for assessing pain in older adults with cognitive impairment. It is used in clinical practice and research. However, evidence for its measurement properties, feasibility and clinical utility remain incomplete. This systematic review synthesizes previous research on the measurement properties, feasibility and clinical utility of the scale. Method We conducted a systematic search in three databases (CINAHL, Medline and PsycINFO) for studies published in English, French, German, Dutch/Flemish or a Scandinavian language between 1990 and April 2017. We also reviewed the Doloplus-2 homepage and reference lists of included studies to supplement our search. Two reviewers independently reviewed titles and abstracts and performed the quality assessment and data abstraction. Results A total of 24 studies were included in this systematic review. The quality of the studies varied, but many lacked sufficient detail about the samples and response rates. The Doloplus-2 has been studied using diverse samples in a variety of settings; most study participants were in long-term care and in people with dementia. Sixteen studies addressed various aspects of the scale’s feasibility and clinical utility, but their results are limited and inconsistent across settings and samples. Support for the scale’s reliability, validity and responsiveness varied widely across the studies. Generally, the reliability coefficients reached acceptable benchmarks, but the evidence for different aspects of the scale’s validity and responsiveness was incomplete. Conclusion Additional high-quality studies are warranted to determine in which populations of older adults with cognitive impairment the Doloplus-2 is reliable, valid and feasible. The ability of the Doloplus-2 to meaningfully quantify pain, measure treatment response and improve patient outcomes also needs further investigation. Trial registration PROSPERO reg. no.: CRD42016049697 registered 20. Oct. 2016. Electronic supplementary material The online version of this article (10.1186/s12877-017-0643-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanne Marie Rostad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway. .,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway.
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway.,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway.,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway
| | - Martine Puts
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway.,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway
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Rostad HM, Puts M, Småstuen MC, Utne I, Grov EK, Halvorsrud L. [P1–630]: THE IMPACT OF PAIN ON QUALITY OF LIFE AND THE MEDIATING ROLE OF ACTIVITIES OF DAILY LIVING AND DEPRESSIVE SYMPTOMS IN SEVERE DEMENTIA. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | - Inger Utne
- Oslo and Akershus University College of Applied SciencesOsloNorway
| | | | - Liv Halvorsrud
- Oslo and Akershus University College of Applied SciencesOsloNorway
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14
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Rostad HM, Puts MTE, Cvancarova Småstuen M, Grov EK, Utne I, Halvorsrud L. Associations between Pain and Quality of Life in Severe Dementia: A Norwegian Cross-Sectional Study. Dement Geriatr Cogn Dis Extra 2017; 7:109-121. [PMID: 28553313 PMCID: PMC5425768 DOI: 10.1159/000468923] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/03/2017] [Indexed: 12/19/2022] Open
Abstract
Background/Aims Many variables influence the quality of life in older adults with dementia. We aim to quantify how the relationship between pain and quality of life in nursing home residents with severe dementia can be explained by neuropsychiatric symptoms, depressive symptoms, and activities of daily living. Methods This article presents cross-sectional baseline data from a cluster randomised controlled trial. Results The total and direct effects of pain on quality of life were statistically significant. Both neuropsychiatric and depressive symptoms partially mediated the relationship between pain and quality of life. Activities of daily living acted as a mediator only when modelled together with depressive symptoms. Conclusion Pain, neuropsychiatric symptoms, and depressive symptoms appear to be important factors that influence the quality of life for nursing home residents with severe dementia. Therefore, multidimensional interventions may be beneficial for maintaining or improving quality of life in this population.
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Affiliation(s)
- Hanne Marie Rostad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Milada Cvancarova Småstuen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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