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Brown P, Cooper C, Dening KH, Hoe J, Burton A. An exploration of how specialist dementia nurses perceive and maintain the skills and competencies that frame their specialism: A qualitative survey. Heliyon 2024; 10:e27856. [PMID: 38596077 PMCID: PMC11001773 DOI: 10.1016/j.heliyon.2024.e27856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024] Open
Abstract
Background UK policy for complex and long-term health conditions including dementia has recommended that specialist nursing intervention is offered across the trajectory of the condition, but there is a lack of agreement regarding the skills and competencies that specialist nurses are expected to possess. Admiral Nurses are the largest UK group of specialist dementia nurses. Objective To explore how Admiral Nurses met and were supported to meet competencies as defined in the Admiral Nurse Competency Framework, and to develop and maintain skills as dementia specialists. Design Cross-sectional, semi-structured survey. Setting Online national survey. Participants Admiral (specialist dementia) Nurses. Methods We co-designed our survey with Admiral Nurses; then invited Admiral Nurses to complete it in 2022-23 Data were analysed thematically. Results 68 (20% of all Admiral Nurses) completed the survey; most were female (85.2%), from a white ethnic group (88.2%); they reported on average 24 years of nursing experience. We identified three themes in responses: 1.Having time and skills for meaningful support, explored how participants were resourced with time and skills to understand and address family carer client needs by active listening, tailoring person-centred support, and "walking alongside" families. 2.Partnering family carers, concerned how they co-designed interventions with family carers, learning from these collaborative partnerships where expertise was shared. 3.Practice and peer-based learning, explored how participants took responsibility for using available training, peer learning and self-reflection to develop their practice. Conclusions Admiral Nurse roles enabled respondents to develop as autonomous practitioners and to access resources that supported them to build and sustain their dementia specialist practice. Learning was practice based, through partnerships with family carer clients, peer support and self-directed learning. Specialist nursing models may help address the global health workforce emergency, through enabling creative practice development and valued roles that support retention of experienced nurses.
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Affiliation(s)
- Pat Brown
- Division of Psychiatry, University College London, London, UK & Dementia UK, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK, And East London NHS Foundation Trust
| | - Karen Harrison Dening
- School of Health & Life Sciences, De Montfort University, Leicester, Leicestershire & Dementia UK, London, UK
| | - Juanita Hoe
- Geller Institute of Ageing and Memory (GIAM), University of West London, London, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, London, UK
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Nishimura M, Harrison Dening K, Sampson EL, Vidal EIDO, Nakanishi M, Davies N, Abreu W, Kaasalainen S, Eisenmann Y, Dempsey L, Moore KJ, Bolt SR, Meijers JMM, Dekker NL, Miyashita M, Nakayama T, van der Steen JT. A palliative care goals model for people with dementia and their family: Consensus achieved in an international Delphi study. Palliat Med 2024; 38:457-470. [PMID: 38634232 PMCID: PMC11025301 DOI: 10.1177/02692163241234579] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. AIM To develop a multidimensional international palliative care goals model in dementia for use in practice. DESIGN International Delphi study integrating consensus and evidence from a meta-qualitative study. The Delphi panel rated statements about the model on a 5-point agreement scale. The criteria for consensus were pre-specified. SETTING/PARTICIPANTS Seventeen researchers from eight countries developed an initial model, and 169 candidate panellists were invited to the international online Delphi study. RESULTS Panellists (107; response 63.3%) resided in 33 countries. The model comprised four main care goals: (1) Comfort ensured; (2) Control over function maintained; (3) Identity protected and personhood respected and (4) Coping with grief and loss-person and caregiver supported. The model reflects how needs and care goals change over time with the progression of dementia, concluding with bereavement support. The first version of the model achieved a consensus after which it was slightly refined based on feedback. We did not achieve a consensus on adding a goal of life prolongation, and on use of the model by people with dementia and family themselves. CONCLUSION A new palliative care goals model for people with dementia and their families includes relationship aspects for use by professionals and achieved a consensus among a panel with diverse cultural background. The position of life prolongation in relation to palliative care goals needs further research.
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Affiliation(s)
- Mayumi Nishimura
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | | | - Elizabeth L Sampson
- Royal London Hospital and Centre for Psychiatry and Mental health, East London NHS Foundation Trust, London, UK
- Wolfson Institute of Population Health, Queen Mary University London, London, UK
| | | | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Wilson Abreu
- Center for Health Technology and Ser- vices Research, University of Porto (ESEP/CINTESIS), Porto, Portugal
| | | | - Yvonne Eisenmann
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Laura Dempsey
- Department of Nursing and Healthcare, Technological University of the Shannon: Midlands Midwest, Athlone, Ireland
| | - Kirsten J Moore
- National Ageing Research Institute, Parkville, VIC, Australia
- Medicine-Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Sascha R Bolt
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, North Brabant, The Netherlands
| | - Judith MM Meijers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Natashe Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Leiden, South Holland, The Netherlands
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, South Holland, The Netherlands
- Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
- Cicely Saunders Institute, King’s College London, UK
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Aldridge Z, Harrison Dening K. Risk management and decision-making in dementia care. Nurs Older People 2024:e1460. [PMID: 38504558 DOI: 10.7748/nop.2024.e1460] [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] [Accepted: 11/02/2023] [Indexed: 03/21/2024]
Abstract
What constitutes a risk for a person living with dementia may be perceived and prioritised differently by nurses from varying clinical backgrounds. Furthermore, risk may be perceived differently according to the context. This article outlines some of the social, psychological and physical risk factors relevant to people living with dementia across the life course of the condition. It is important that nurses understand their role in identifying, assessing and managing risk and are aware of the resources, policies, legislation and processes designed to support decision-making and minimise the risk of harm to people living with dementia, their families and carers. The authors hope that this article will support nurses to become more confident in identifying risk while encouraging them to adopt a proactive and person-centred approach to risk assessment and management.
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van der Steen JT, Nakanishi M, Van den Block L, Di Giulio P, Gonella S, in der Schmitten J, Sudore RL, Harrison Dening K, Parker D, Mimica N, Holmerova I, Larkin P, Martins Pereira S, Rietjens JAC, Korfage IJ. Consensus definition of advance care planning in dementia: A 33-country Delphi study. Alzheimers Dement 2024; 20:1309-1320. [PMID: 37985444 PMCID: PMC10916978 DOI: 10.1002/alz.13526] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Existing advance care planning (ACP) definitional frameworks apply to individuals with decision-making capacity. We aimed to conceptualize ACP for dementia in terms of its definition and issues that deserve particular attention. METHODS Delphi study with phases: (A) adaptation of a generic ACP framework by a task force of the European Association for Palliative Care (EAPC); (B) four online surveys by 107 experts from 33 countries, September 2021 to June 2022; (C) approval by the EAPC board. RESULTS ACP in dementia was defined as a communication process adapted to the person's capacity, which includes, and is continued with, family if available. We identified pragmatic boundaries regarding participation and time (i.e., current or end-of-life care). Three interrelated issues that deserve particular attention were capacity, family, and engagement and communication. DISCUSSION A communication and relationship-centered definitional framework of ACP in dementia evolved through international consensus supporting inclusiveness of persons with dementia and their family. HIGHLIGHTS This article offers a consensus definitional framework of advance care planning in dementia. The definition covers all stages of capacity and includes family caregivers. Particularly important are (1) capacity, (2) family, (3) engagement, and communication. Fluctuating capacity was visualized in relation to roles and engaging stakeholders.
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Affiliation(s)
- Jenny T. van der Steen
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
- Department of Primary and Community Care, and Radboudumc Alzheimer CenterRadboud university medical centerNijmegenThe Netherlands
| | - Miharu Nakanishi
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
- Department of Psychiatric NursingTohoku University Graduate School of MedicineAoba‐kuSendai‐shi MiyagyJapan
| | - Lieve Van den Block
- VUB‐UGent End‐of‐Life Care Research GroupVrije Universiteit Brussel (VUB)BrusselsBelgium
| | - Paola Di Giulio
- Department of Public Health Sciences and PediatricsTurin UniversityTurinItaly
| | - Silvia Gonella
- Direction of Health ProfessionsCity of Health and Science University Hospital of TurinTurinItaly
| | - Jürgen in der Schmitten
- Institute for General Practice/Family MedicineMedical FacultyUniversity of Duisburg‐EssenEssenGermany
| | - Rebecca L. Sudore
- Division of GeriatricsDepartment of MedicineUniversity of California [more locations]San FranciscoCaliforniaUSA
- San Francisco Veterans Affairs Medical CenterSan FranciscoCaliforniaUSA
| | - Karen Harrison Dening
- Research & PublicationsDementia UKLondonUK
- Faculty of Health & Life SciencesDe Montfort UniversityLeicesterUK
| | - Deborah Parker
- IMPACCT/School of Nursing and MidwiferyFaculty of HealthUniversity of TechnologySydneyAustralia
| | - Ninoslav Mimica
- University Psychiatric Hospital VrapčeSchool of MedicineUniversity of ZagrebZagrebCroatia
| | - Iva Holmerova
- Faculty of HumanitiesCentre of Expertise in Longevity and Long‐Term Care and Centre of GerontologyCharles UniversityPragueCzech Republic
| | - Philip Larkin
- Palliative and Supportive Care Service and Institute of Higher Education and Research in HealthcareUNIL, Université de LausanneCHUV, Centre hospitalier universitaire VaudoisFaculté de biologie et de médecine – FBM Institut universitaire de formation et de recherche en soins – Hôpital NestléLausanneSwitzerland
| | - Sandra Martins Pereira
- CEGE: Research Center in Management and Economics – Ethics and Sustainability Research AreaUniversidade Católica PortuguesaCatólica Porto Business SchoolPortoPortugal
| | - Judith A. C. Rietjens
- Department of Public HealthErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
- Department of DesignOrganisation and StrategyFaculty of Industrial Design EngineeringDelft University of TechnologyDelftThe Netherlands
| | - Ida J. Korfage
- Department of Public HealthErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
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Abstract
People with dementia of all stages and subtypes can experience challenges with communicating. Therefore, it is vital that community nurses working with people with dementia have an understanding of the ways in which communication might be challenged, and that they have skills in communicating effectively. This article presents an overview of the ways in which dementia might impact on communication and offers the model of person-centred dementia care as a way of communicating effectively. The use of person-centred communication in practice is illustrated through a case study approach, highlighting the practical approaches that can be used by community nurses in their practice.
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Affiliation(s)
- Amy Pepper
- Admiral Nurse Research Assistant, Dementia UK
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Rose T, Dening KH. Who am I? Identity, person-centred care and dementia. Nurs Older People 2023; 35:22-27. [PMID: 37464806 DOI: 10.7748/nop.2023.e1446] [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] [Accepted: 05/17/2023] [Indexed: 07/20/2023]
Abstract
Identity is a central aspect of our lives. Who we believe ourselves to be has profound implications on how we interact with and interpret the world around us. People with dementia often experience stigma and suboptimal care because of a perception that they have 'lost their identity' as the cognitive symptoms associated with the condition progress. This notion is challenged by proponents of person-centred care who argue that a person's identity and worth are based on more than cognitive abilities. Person-centred care is a holistic approach that takes account of the entirety of a person's life and provides support that respects the individual and their self-identity. Since identity is vital to well-being, delivery of person-centred care must involve actively seeking a person's concept of self to tailor their care to meet all their needs. This article considers the importance of identity and personhood for people with dementia and their carers in the context of person-centred care. The article includes two case studies to illustrate these concepts in practice.
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Affiliation(s)
- Tom Rose
- St Barnabas Hospice, Lincoln, England
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Dening KH. Caring for a person living with dementia: identifying and assessing a carer's needs. Br J Community Nurs 2023; 28:492-496. [PMID: 37793112 DOI: 10.12968/bjcn.2023.28.10.492] [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] [Indexed: 10/06/2023]
Abstract
As the population ages and so do the numbers of people with dementia, there will also be an increase in the number of unpaid family carers. Estimates suggest that one in three of us will become a carer for someone with dementia during our lifetime, some caring for more than one person diagnosed with dementia in their family. There are currently over 700 000 people in the UK acting as primary unpaid carers for people with dementia, all of whom make a substantial contribution, both financially and physically, to their care and support. Carers of people with dementia can experience high levels of carer burden and distress as well poor health and wellbeing due to their caring roles. However, they can sometimes be less than visible to health and social care services as they may not identify themselves as carers or their needs may not be easily recognised which leaves them at risk. Identifying people in caring roles and assessing their needs are the first two steps in supporting them. Community nurses are well placed to do this within their roles.
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Affiliation(s)
- Karen Harrison Dening
- Head of Research and Publications, Dementia UK; Honarary Professor of Dementia Nursing, De Montfort University, Leicester, UK
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Harrison Dening K. Assessing and managing pain in older people with dementia. Nurs Stand 2023; 38:69-75. [PMID: 37574998 DOI: 10.7748/ns.2023.e12165] [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] [Accepted: 05/25/2023] [Indexed: 08/15/2023]
Abstract
There is little evidence to suggest that people with dementia experience less pain than those without dementia, however they are less likely to report their pain due to the cognitive impairments they experience as their dementia progresses. A comprehensive pain assessment that involves family members, carers and/or friends in the process is crucial to gain an understanding of a person's medical and pain history, and to ensure effective pain management in people with dementia. This article describes the identification, assessment and management of pain in older people with dementia. The author includes a fictional case study with the aim of supporting nurses to reflect on possible indicators of pain in a person with dementia and to consider the tools they may use when identifying and assessing this pain.
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Dening KH. Modifiable and non-modifiable risk factors for dementia: what primary care nurses need to know. Br J Community Nurs 2023; 28:430-438. [PMID: 37638750 DOI: 10.12968/bjcn.2023.28.9.430] [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] [Indexed: 08/29/2023]
Abstract
Dementia is an umbrella term used to describe a group of symptoms characterised by behavioural changes, loss of cognitive and social functioning brought about by progressive neurological disorders. There are estimated to be 944 000 people living with dementia in the UK and it is indicated that this will increase to 2 million by 2051. We are learning more about the risk factors for developing dementia over the life course. This paper discusses the modifiable and non-modifiable risk factors for dementia and considers health promotion and health education activities that can be used in a primary care setting.
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Affiliation(s)
- Karen Harrison Dening
- Head of Research and Publications, Dementia UK; Honorary Professor of Dementia Research, De Montfort University Gateway House, Leicester, UK
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Abstract
PURPOSE OF REVIEW Dementia policy priorities recommend that people who are living with dementia and their family should have access to support and interventions delivered by dementia specialists, including specialist nurses. However, specialist dementia nursing models and role-related competencies are not clearly defined. We systematically review the current evidence regarding specialist dementia nursing models and their impacts. RECENT FINDINGS Thirty-one studies from across three databases, and grey literature were included in the review. One framework defining specific specialist dementia nursing competencies was found. We did not find convincing evidence of the effectiveness of specialist nursing dementia services, relative to standard models of care from the current, limited evidence base, although families living with dementia valued it. No Randomised Controlled Trial (RCT) has compared the impact of specialist nursing on client and carer outcomes relative to less specialist care, although one nonrandomised study reported that specialist dementia nursing reduces emergency and inpatient service use compared with a usual care group. SUMMARY Current models of specialist dementia nursing are numerous and heterogeneous. Further exploration of the specialist nursing skills and the impact of specialist nursing interventions is needed to usefully inform workforce development strategies and clinical practice.
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Affiliation(s)
- Pat Brown
- Division of Psychiatry, University college London, and Dementia UK
| | | | - Jordan Ayden
- Division of Psychiatry, University College London
| | - Karen Harrison Dening
- Faculty of Health and Life Sciences, De Montfort University, Leicester, and Dementia UK
| | - Juanita Hoe
- Geller Institute of Ageing and Memory (GIAM), University of West London
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Griffiths S, Spencer E, Wilcock J, Bamford C, Wheatley A, Brunskill G, D'Andrea F, Walters KR, Lago N, O'Keeffe A, Hunter R, Tuijt R, Harrison Dening K, Banerjee S, Manthorpe J, Allan L, Robinson L, Rait G. Protocol for the feasibility and implementation study of a model of best practice in primary care led postdiagnostic dementia care: PriDem. BMJ Open 2023; 13:e070868. [PMID: 37597869 PMCID: PMC10441044 DOI: 10.1136/bmjopen-2022-070868] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/03/2023] [Indexed: 08/21/2023] Open
Abstract
INTRODUCTION Care is often inadequate and poorly integrated after a dementia diagnosis. Research and policy highlight the unaffordability and unsustainability of specialist-led support, and instead suggest a task-shared model, led by primary care. This study is part of the PriDem primary care led postdiagnostic dementia care research programme and will assess delivery of an evidence-informed, primary care based, person-centred intervention. The intervention involves Clinical Dementia Leads (CDLs) working in primary care to develop effective dementia care systems that build workforce capacity and support teams to deliver tailored support to people living with dementia and their carers. METHODS AND ANALYSIS This is a 15-month mixed-methods feasibility and implementation study, situated in four National Health Service (NHS) primary care networks in England. The primary outcome is adoption of personalised care planning by participating general practices, assessed through a patient records audit. Feasibility outcomes include recruitment and retention; appropriateness and acceptability of outcome measures; acceptability, feasibility and fidelity of intervention components. People living with dementia (n=80) and carers (n=66) will be recruited through participating general practices and will complete standardised measures of health and well-being. Participant service use data will be extracted from electronic medical records. A process evaluation will explore implementation barriers and facilitators through methods including semistructured interviews with people living with dementia, carers and professionals; observation of CDL engagement with practice staff; and a practice fidelity log. Process evaluation data will be analysed qualitatively using codebook thematic analysis, and quantitatively using descriptive statistics. Economic analysis will determine intervention cost-effectiveness. ETHICS AND DISSEMINATION The study has received favourable ethical opinion from Wales REC4. NHS Confidentiality Advisory Group support allows researchers preconsent access to patient data. Results will inform intervention adaptations and a future large-scale evaluation. Dissemination through peer-review journals, engagement with policy-makers and conferences will inform recommendations for dementia services commissioning. TRIAL REGISTRATION NUMBER ISRCTN11677384.
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Affiliation(s)
- Sarah Griffiths
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Emily Spencer
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alison Wheatley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Brunskill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Federica D'Andrea
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - Kate R Walters
- Research Department of Primary Care & Population Health, UCL, London, UK
| | | | - Aidan O'Keeffe
- Mathematical Sciences, University of Nottingham, Nottingham, UK
| | - Rachael Hunter
- Research Department of Primary Care & Population Health, UCL, London, UK
| | | | | | - Sube Banerjee
- Office of Vice Chancellor, University of Plymouth, Plymouth, UK
| | - Jill Manthorpe
- Health & Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Rait
- Research Department of Primary Care & Population Health, UCL, London, UK
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Harrison Dening K. Dementia: recognition and cognitive testing in community and primary care settings. Br J Community Nurs 2023; 28:332-336. [PMID: 37369436 DOI: 10.12968/bjcn.2023.28.7.332] [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] [Indexed: 06/29/2023]
Abstract
Dementia is an umbrella term used to describe a group of symptoms characterised by behavioural changes, as well as loss of cognitive and social functioning brought about by progressive neurological disorders. There are approximately 944 000 people living with dementia in the UK and estimates indicate this will increase to over 2 million by 2051. Dementia, if left undiagnosed, can have an insidious and harmful impact on the people and their families who are affected by it. A timely diagnosis can be made when a person with a possible dementia comes to the attention of clinicians due to concerns about changes in their cognition, behaviour, or functioning. Community nurses are well-placed to observe changes in their older patients, which may be indicative of early dementia. This paper uses a case study to illustrate possible early signs of dementia and discusses the recognition and initial cognitive tests that can be used in a primary care setting.
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Affiliation(s)
- Karen Harrison Dening
- Dementia UK; Honorary Professor of Dementia Research, De Montfort University Gateway House, Leicester
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13
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Dixon J, Lorenz-Dant K, Stubbs E, Harrison Dening K, Mostaghim M, Casson D. Registered care home managers' experiences of responding to the national care home visiting guidance in England during the Covid-19 pandemic; a multi-method qualitative study. BMC Geriatr 2023; 23:236. [PMID: 37076808 PMCID: PMC10113990 DOI: 10.1186/s12877-023-03935-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/26/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Visiting restrictions in care homes in England and many comparable countries during the Covid-19 pandemic were extensive and prolonged. We examined how care home managers experienced, understood and responded to the national care home visiting guidance in England in developing their visiting policies. METHODS A diverse sample of 121 care home managers across England, recruited through varied sources including the NIHR ENRICH network of care homes, completed a 10-item qualitative survey. Follow-up, in-depth qualitative interviews were conducted with a purposive sub-sample of 40 managers. Data were analysed thematically using Framework, a theoretically and methodologically flexible tool for data analysis in multiple researcher teams. FINDINGS Some viewed the national guidance positively; as supporting the restrictive measures they felt necessary to protect residents and staff from infection, or as setting a broad policy framework while allowing local discretion. More commonly, however, managers experienced challenges. These included the guidance being issued late; the initial document and frequent, media-led updates not being user-friendly; important gaps, particularly in relation to dementia and the risks and harms associated with restrictions; guidance being unhelpfully open to interpretation while restrictive interpretations by regulators limited apparent scope for discretion; fragmented systems of local governance and poor central-local coordination; inconsistent access and quality of support from local regulators wider sources of information, advice and support that, while often valued, were experienced as uncoordinated, duplicative and sometimes confusing; and insufficient account taken of workforce challenges. CONCLUSIONS Underlying many of the challenges experienced were structural issues, for which there have been longstanding calls for investment and strategic reform. For increasing sector resilience, these should be are urgently addressed. Future guidance would also be significantly strengthened by gathering better data, supporting well-facilitated peer exchange, engaging the sector more fully and dynamically in policy-making and learning from care home managers' and staff's experiences, particularly of assessing, managing and mitigating the wider risks and harms associated with visiting restrictions.
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Affiliation(s)
- Josie Dixon
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Klara Lorenz-Dant
- University of Augsburg, Universitätsstraße 2, 86159, Augsburg, Germany
| | - Edmund Stubbs
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Karen Harrison Dening
- De Montfort University, The Gateway, Leicester, LE1 9BH, UK
- Dementia UK, 7th Floor, One Aldgate, London, EC3N 1RE, UK
| | - Manna Mostaghim
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Daniel Casson
- Care England, 2nd Floor, 2 Devonshire Square, London, EC2M 4UJ, UK
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Wolverson E, Harrison Dening K, Gower Z, Brown P, Cox J, McGrath V, Pepper A, Prichard J. What are the information needs of people with dementia and their family caregivers when they are admitted to a mental health ward and do current ward patient information leaflets meet their needs? Health Expect 2023; 26:1227-1235. [PMID: 36934455 PMCID: PMC10154859 DOI: 10.1111/hex.13738] [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: 12/14/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 03/20/2023] Open
Abstract
INTRODUCTION An admission to a mental health ward is an uncertain and unexpected part of a person's journey with dementia and consequently, families require information about what to expect and how to prepare. This study aimed to establish the information needs of people with dementia and their families at the point of admission to a mental health ward and to collate existing ward information leaflets to explore if they meet these information needs. METHODS This research was conducted in two parts: (1) a qualitative study using focus groups, one with people with dementia and family carers with lived experience of such an admission (n = 6), and another with Admiral Nurses (n = 6) to explore information needs at the point of admission. (2) Each National Health Service (NHS) mental health trust (n = 67) was asked to provide a copy of their ward information shared at admission. A total of 30 leaflets were received from 15 NHS trusts; after removing duplicates, 22 were included. A content analysis was conducted to evaluate to what extent leaflets met the information needs identified by focus groups. RESULTS Two main categories 'honest, accurate and up-to-date information' and 'who is the information for' and four subcategories were derived from focus group data. Participants felt that people with dementia and their families were likely to have different information needs. Material for people with dementia needed to be in an accessible format. Information should cover the aim of the admission, a timeline of what to expect and details about how families will be involved in care. Practical information about what to pack and ward facilities was valued. Participants spoke about the need to consider the tone of the information, given that people are likely to be distressed. The information leaflets reviewed did not meet the information needs identified by focus group participants. CONCLUSIONS People with dementia and family carers have different information needs at the point of admission to a mental health ward. Information provided to people with dementia needs to be in an accessible format with content relevant to these needs. Wards should aim to co-create information to ensure that they meet people's information needs. PATIENT OR PUBLIC CONTRIBUTION This research was supported by a patient and public involvement (PPI) group of people with dementia and carers who have experience in mental health wards. The idea for the study came from the group and was motivated by their experiences. The PPI group helped with the design of the study and took part in the focus groups. The information generated has been written up in this paper, and the knowledge generated has also been used to co-create a guide for wards on writing their information leaflets and to support the co-creation of a public information leaflet by Dementia UK about mental health admissions for people with dementia.
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Affiliation(s)
- Emma Wolverson
- School of Psychology and Social Work, University of Hull, Hull, UK.,Dementia UK, London, UK
| | | | - Zoe Gower
- Humber Teaching NHS Foundation Trust, Hull, UK
| | - Pat Brown
- Dementia UK, London, UK.,Mental Health Neuroscience, University College London, London, UK
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15
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Brown P, Harrison Dening K. Assessing and managing agitation as a symptom of dementia. Nurs Older People 2023; 35:e1433. [PMID: 36883890 DOI: 10.7748/nop.2023.e1433] [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] [Accepted: 01/09/2023] [Indexed: 03/09/2023]
Abstract
Behavioural and psychological symptoms of dementia (BPSD) affect more than one third of people with dementia at some point during the course of their condition. Agitation is the third most common BPSD but is the least well understood in terms of identification and management. Furthermore, agitation as a symptom of dementia is often confused with agitation as a way of expressing an emotion or unmet need. Psychosocial interventions are recommended to support the person with dementia and their family carers to manage agitation as a symptom of dementia, as well as other BPSD, in a person-centred manner. Some psychosocial interventions for managing agitation as a symptom of dementia have shown benefits, but further investigation of the usefulness of a range of interventions is needed. This article discusses the assessment and management of agitation as a symptom of dementia and illustrates their application through a case study.
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Affiliation(s)
- Pat Brown
- Dementia UK, London, England and PhD student, University College London, London, England
| | - Karen Harrison Dening
- Dementia UK, London, England and honorary professor of dementia nursing, De Montfort University, Leicester, England
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16
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Dening KH, Aldridge Z, Hayo H. Admiral Nursing: supporting generalist nurses to work with families affected by dementia. Nurs Stand 2023; 38:41-45. [PMID: 36519394 DOI: 10.7748/ns.2022.e12006] [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] [Accepted: 06/30/2022] [Indexed: 06/17/2023]
Abstract
The number of people with dementia in the UK is expected to significantly increase over the next two decades, which has implications for service demand and delivery, as well as for the development of the workforce across all health and social care services. The health and social care workforce requires a range of knowledge and skills to enable staff to meet the complex needs of people with dementia and their families. In the UK, a framework outlining dementia training standards was developed to address this; however, the quality and efficacy of this training is unclear and there are growing doubts that such a 'one-size-fits-all' approach can meet the diverse needs of the workforce. This article discusses the education needs of the health and social care workforce in relation to dementia and outlines how the specialist role of the Admiral Nurse can support these needs. The article also details two case studies that demonstrate the role of the Admiral Nurse in identifying and supporting the education needs of generalist nurses working in acute hospital and primary care settings.
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17
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Pepper A, Dening KH. Person-centred communication with people with dementia. Nurs Older People 2023; 35:e1430. [PMID: 36694988 DOI: 10.7748/nop.2023.e1430] [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] [Accepted: 11/03/2022] [Indexed: 01/26/2023]
Abstract
Communication is a two-way process of exchanging or sharing information and is an essential element of the nursing process. Challenges with communication are a feature of all types of dementia, so understanding how dementia affects communication and how to support people is important for all nurses. This article provides an overview of communication in dementia care. The authors draw on the literature on communication and dementia to present evidence-based, practical approaches for supporting person-centred communication with people with dementia.
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18
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Wolverson EL, Harrison Dening K, Dunning R, Crowther G, Russell G, Underwood BR. Family experiences of inpatient mental health care for people with dementia. Front Psychiatry 2023; 14:1093894. [PMID: 36937714 PMCID: PMC10016091 DOI: 10.3389/fpsyt.2023.1093894] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/09/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction This study investigates family carers experiences of inpatient mental health care for people with dementia. A mental health inpatient admission for a person with dementia is usually considered when a person is distressed and this distress leads to behaviours that are assessed to be risky for the person or others. Methods Participants included seven family carers whose relative with dementia had been cared for within a mental health ward in the United Kingdom UK within the last 5 years. Interviews were used to explore the circumstances that led to the admission, expectations of mental health care, and perceptions of care during the admission and support received by family carers. Results Participants described their distress at the time of admission and how the process of admission sometimes added to their distress. Carers often felt excluded from their relatives care in hospital and many felt a loss of their rights. Participants felt that the mental health admission had a negative impact on their relative with dementia. Mental health law and legislation was difficult to navigate and carers were concerned about how much knowledge and understanding of dementia staff have. Discussion Findings suggest that family carers may benefit from targeted support during their relatives admission. Mental health wards could do more to recognise the expertise in care and knowledge of the person with dementia of family carers and involve them in planning care. More research is needed to explore the experiences and outcomes of people with dementia during such admissions.
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Affiliation(s)
- Emma L. Wolverson
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
- Dementia UK, London, United Kingdom
- *Correspondence: Emma L. Wolverson,
| | | | | | - George Crowther
- Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
- Leeds Institute of Health Science, University of Leeds, Leeds, United Kingdom
| | - Gregor Russell
- Leeds Institute of Health Science, University of Leeds, Leeds, United Kingdom
- Bradford District Care NHS Foundation Trust, Osprey House, Lynfield Mount Hospital, Bradford, United Kingdom
| | - Benjamin R. Underwood
- Cambridgeshire and Peterborough NHS Foundation Trust, Windsor Unit, Fulbourn Hospital, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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19
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Bamford C, Wilcock J, Brunskill G, Wheatley A, Harrison Dening K, Manthorpe J, Allan L, Banerjee S, Booi L, Griffiths S, Rait G, Walters K, Robinson L. Improving primary care based post-diagnostic support for people living with dementia and carers: Developing a complex intervention using the Theory of Change. PLoS One 2023; 18:e0283818. [PMID: 37134099 PMCID: PMC10155958 DOI: 10.1371/journal.pone.0283818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/17/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The need to improve support following a diagnosis of dementia is widely recognised, but it is unclear how this can best be achieved within UK health and social care systems. A task-shared and task-shifted approach has been recommended, but there is limited guidance on how to achieve this in practice. As part of a programme of research, we developed an intervention to enhance the role of primary care in post-diagnostic care and support for people living with dementia and carers. METHODS We used the Theory of Change to develop a complex intervention informed by initial literature reviews and qualitative work. The intervention was developed through an iterative series of workshops, meetings and task groups with a range of stakeholders, including the multidisciplinary project team, people living with dementia and carers, service managers, frontline practitioners, and commissioners. RESULTS 142 participants contributed to intervention development through face-to-face or virtual meetings. The intervention comprises three complementary strands of work focusing on: developing systems, delivering tailored care and support, and building capacity and capability. Clinical dementia leads, based in primary care networks, will facilitate the intervention providing tailored expertise and support. CONCLUSION The Theory of Change proved useful in providing structure and engaging stakeholders. The process was challenging, took longer and was less participative than intended due to restrictions caused by the COVID-19 pandemic. We will next conduct a feasibility and implementation study to explore whether the intervention can be successfully delivered within primary care. If successful, the intervention offers practical strategies for delivering a task-shared and task-shifted approach to post-diagnostic support that could be adapted for similar health and social care contexts internationally.
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Affiliation(s)
- Claire Bamford
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Greta Brunskill
- Voluntary Organisations Network North East, Newcastle, United Kingdom
| | - Alison Wheatley
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute at King's, King's College London, London, United Kingdom
| | - Louise Allan
- South Cloisters, University of Exeter, Exeter, United Kingdom
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Laura Booi
- Centre for Dementia Research, Leeds Beckett University, Leeds, United Kingdom
| | - Sarah Griffiths
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Greta Rait
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Kate Walters
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
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20
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Brown LJE, Aldridge Z, Pepper A, Leroi I, Dening KH. 'It's just incredible the difference it has made': family carers' experiences of a specialist Lewy body dementia Admiral Nurse service. Age Ageing 2022; 51:6754357. [PMID: 36209508 PMCID: PMC9548332 DOI: 10.1093/ageing/afac207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/28/2022] [Revised: 04/27/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Lewy body dementia (LBD) is characterised by a complex array of symptoms. Being a family carer of someone with LBD can be challenging, and is associated with high levels of stress, depression and anxiety. Admiral Nursing services support family carers of people with dementia in the UK by providing tailored information, advice and therapeutic support. Recently, the Admiral Nurse model has been adapted to the needs of more specific populations, including the introduction of a new, specialist LBD Admiral Nurse. OBJECTIVE to explore family carers' experiences of the LBD Admiral Nurse service. METHODS fourteen family carers of people with LBD were interviewed about their experiences of the LBD Admiral Nurse service. Interview transcripts were analysed using thematic analysis. RESULTS four themes were identified: theme 1 described how participants valued the LBD Admiral Nurse's specialist expertise, which contrasted with the lack of knowledge they encountered in other services. In theme 2, participants described how the practical, tailored support provided by the LBD Admiral Nurse enabled them to better manage a variety of caring-related challenges. Theme 3 captured the emotional benefits that participants gained from being able to talk to someone who understood their situation. In theme 4, participants explained how the reliability of the LBD Admiral Nurse's support helped them feel supported in their role. CONCLUSIONS the specialist knowledge and expertise of the LBD Admiral Nurse enabled family carers to better support the people they cared for, and to relieve some of the emotional stress associated with caring.
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Affiliation(s)
- Laura J E Brown
- Address correspondence to: Laura J. E. Brown, University of Manchester, Room 2.32, Second Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK. Tel: +44 (0)161 275 2563.
| | - Zena Aldridge
- Dementia UK, London, UK,Faculty of Health & Life Sciences, De Montfort University, Leicester, UK
| | | | - Iracema Leroi
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Karen Harrison Dening
- Dementia UK, London, UK,Faculty of Health & Life Sciences, De Montfort University, Leicester, UK
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21
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Nishimura M, Dening KH, Sampson EL, de Oliveira Vidal EI, de Abreu WC, Kaasalainen S, Eisenmann Y, Dempsey L, Moore KJ, Davies N, Bolt SR, Meijers JMM, Dekker NL, Miyashita M, Nakanishi M, Nakayama T, van der Steen JT. Cross-cultural conceptualization of a good end of life with dementia: a qualitative study. Palliat Care 2022; 21:106. [PMID: 35676673 PMCID: PMC9175529 DOI: 10.1186/s12904-022-00982-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/19/2022] [Indexed: 09/25/2023] Open
Abstract
Background Research on the nature of a “good death” has mostly focused on dying with cancer and other life-limiting diseases, but less so on dementia. Conceptualizing common cross-cultural themes regarding a good end of life in dementia will enable developing international care models. Methods We combined published qualitative studies about end of life with dementia, focus group and individual interviews with the researchers, and video-conferencing and continuous email discussions. The interviews were audio-recorded and transcribed verbatim. The data were analyzed thematically, and the researchers developed common themes referring to their original studies. Results Fourteen qualitative researchers representing 14 cross-cultural studies covering qualitative data of 121 people with dementia and 292 family caregivers. The researchers and data were from eight countries UK, The Netherlands, Japan, Portugal, Germany, Canada, Brazil, and Ireland. Three focus groups, five individual interviews, and video-conferencing were conducted and feedback on multiple iterations was gained by 190 emails between May 2019 and April 2020 until consensus was achieved. Nine cross-culturally common themes emerged from the discussions and shared interpretation of the data of persons with dementia and family caregivers. Three represent basic needs: “Pain and Symptoms Controlled,” “Being Provided Basic Care,” and “A Place like Home.” Other themes were “Having Preferences Met,” “Receiving Respect as a Person,” “Care for Caregivers,” “Identity Being Preserved,” “Being Connected,” and “Satisfaction with Life and Spiritual Well-being.” “Care for Caregivers” showed the greatest difference in emphasis across cultures. Good relationships were essential in all themes. Conclusions The common cross-cultural themes comprise a framework underpinned by value placed on personhood and dignity, emphasizing that interdependency through relationships is essential to promote a good end of life with dementia. These themes and valuing the importance of relationships as central to connecting the themes could support care planning and further development of a dementia palliative care model. Trial registration The Graduate School and Faculty of Medicine Kyoto University (R1924–1). Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00982-9.
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Affiliation(s)
- Mayumi Nishimura
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Sakyo-ku, Yoshida Konoe-cho, Kyoto, 606-8501, Japan.
| | | | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, University College London, Gower Street, London, WC1E 6BT, UK
| | - Edison Iglesias de Oliveira Vidal
- Botucatu Medical School, Sao Paulo State University (UNESP), Av. Prof. Mario Rubens Guimaraes Montenegro, Botucatu, SP, 18618-687, Brazil
| | - Wilson Correia de Abreu
- Center for Health Technology and Services Research, University of Porto (ESEP/CINTESIS), R. Dr. Plácido da Costa, 4200-450, Porto, Portugal
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Yvonne Eisenmann
- Department of Palliative Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Laura Dempsey
- Department of Nursing and Healthcare, Technological University of the Shannon: Midlands Midwest, Dublin Road, Athlone, Co Westmeath, N37 HD68, Ireland
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, University College London, Gower Street, London, WC1E 6BT, UK.,National Ageing Research Institute Inc., Royal Melbourne Hospital, Royal Park Campus, Gate 4, Building 8, 34-54 Poplar Rd, Parkville, VIC, 3052, Australia
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, University College London, Gower Street, London, WC1E 6BT, UK.,Research Department of Primary Care and Population Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Sascha R Bolt
- Department of Health Services Research, Care and Public Health Research Institute, Living Lab in Ageing and Long-Term Care, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Judith M M Meijers
- Department of Health Services Research, Care and Public Health Research Institute, Living Lab in Ageing and Long-Term Care, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,Zuyderland Care, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162, BG, Sittard-Geleen, The Netherlands
| | - Natashe Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Pieter de la Court Wassenaarseweg 52, 2333, AK, Leiden, The Netherlands
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Sakyo-ku, Yoshida Konoe-cho, Kyoto, 606-8501, Japan
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333, ZD, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
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22
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Mogan C, Harrison Dening K, Dowrick C, Lloyd-Williams M. Health and social care services for people with dementia at home at the end of life: A qualitative study of bereaved informal caregivers' experiences. Palliat Med 2022; 36:976-985. [PMID: 35466787 PMCID: PMC9174574 DOI: 10.1177/02692163221092624] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND More people are dying at home with dementia and Alzheimer's disease. While informal caregivers are the main providers of care for people with dementia dying at home, they require support from health and social care services. However, little is known about how they experience these services. AIM To explore informal caregivers' views and experiences of health and social care services when looking after a person with dementia at home at the end-of-life. DESIGN A qualitative interview study. Data were analysed using thematic analysis. SETTING/PARTICIPANTS Twenty-nine bereaved informal caregivers who had looked after a person with dementia at home during the last 6 months of life. RESULTS Specialist palliative care for people with dementia dying at home is rare and care is mostly managed by General Practitioners and domiciliary care workers. Four overarching themes were identified: Poor continuity of care; Lack of expertise; Limited advance care planning; and Loss of autonomy. CONCLUSIONS End-of-life care at home for people with dementia must be proactively planned with an emphasis on advance care planning. Policy makers should recognise the critical role of domiciliary care services in end-of-life care and ensure that they are adequately qualified and trained.
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Affiliation(s)
- Caroline Mogan
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Christopher Dowrick
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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23
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Cousins E, Preston N, Doherty J, Varey S, Harding A, McCann A, Harrison Dening K, Finucane A, Carter G, Mitchell G, Brazil K. Implementing and evaluating online advance care planning training in UK nursing homes during COVID-19: findings from the Necessary Discussions multi-site case study project. BMC Geriatr 2022; 22:419. [PMID: 35562712 PMCID: PMC9098790 DOI: 10.1186/s12877-022-03099-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/02/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advance care planning in nursing homes is important to ensure the wishes and preferences of residents are recorded, especially during the COVID-19 pandemic. However, care staff and family members frequently report feeling unprepared for these conversations. More resources are needed to support them with these necessary discussions. This research aimed to develop, implement and evaluate a website intervention for care staff and family members to provide training and information about advance care planning during COVID-19. METHODS The research was a primarily qualitative case study design, comprising multiple UK nursing home cases. Data collection included semi-structured interviews with care staff and family members which were coded and analysed thematically. A narrative synthesis was produced for each case, culminating in a thematic cross-case analysis of the total findings. Theoretical propositions were refined throughout the research. RESULTS Eight nursing homes took part in the study, involving 35 care staff and 19 family members. Findings were reported according to the RE-AIM framework which identified the reach, effectiveness, adoption, implementation and maintenance of the intervention. Themes included: website content that was well received; suggestions for improvement; implementation barriers and facilitators; examples of organisational and personal impact. CONCLUSIONS Four theoretical propositions relating to advance care planning in nursing homes are presented, relating to: training and information needs, accessibility, context, and encouraging conversations. Implications for practice and training include an awareness of diverse learning styles, re-enforcing the right to be involved in advance care planning and encouraging opportunities for facilitated discussion. TRIAL REGISTRATION ISRCTN registry (ID 18003630 ) on 19.05.21.
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Affiliation(s)
- Emily Cousins
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Julie Doherty
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Sandra Varey
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Andrew Harding
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Adrienne McCann
- Innovation Value Institute, Maynooth University, Maynooth & Age Friendly Ireland, Ireland
| | - Karen Harrison Dening
- School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester & Dementia UK, London, UK
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh & Marie Curie Hospice Edinburgh, Edinburgh, UK
| | - Gillian Carter
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
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24
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Bavelaar L, Nicula M, Morris S, Kaasalainen S, Achterberg WP, Loucka M, Vlckova K, Thompson G, Cornally N, Hartigan I, Harding A, Preston N, Walshe C, Cousins E, Dening KH, De Vries K, Brazil K, van der Steen JT. Developing country-specific questions about end-of-life care for nursing home residents with advanced dementia using the nominal group technique with family caregivers. Patient Educ Couns 2022; 105:965-973. [PMID: 34376304 DOI: 10.1016/j.pec.2021.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We aimed to develop question prompt lists (QPLs) for family caregivers of nursing home residents with advanced dementia in the context of a study involving Canada, the Czech Republic, Italy, the Netherlands, the United Kingdom and Ireland, and to explore cross-national differences. QPLs can encourage family caregivers to ask questions about their relative's end-of-life care. METHODS We used nominal group methods to create country-specific QPLs. Family caregivers read an information booklet about end-of-life care for people with dementia, and generated questions to ask healthcare professionals. They also selected questions from a shortlist. We analyzed and compared the QPLs using content analysis. RESULTS Four to 20 family caregivers per country were involved. QPLs ranged from 15 to 24 questions. A quarter (24%) of the questions appeared in more than one country's QPL. One question was included in all QPLs: "Can you tell me more about palliative care in dementia?". CONCLUSION Family caregivers have many questions about dementia palliative care, but the local context may influence which questions specifically. Local end-user input is thus important to customize QPLs. PRACTICE IMPLICATIONS Prompts for family caregivers should attend to the unique information preferences among different countries. Further research is needed to evaluate the QPLs' use.
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Affiliation(s)
- Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Nicula
- School of Nursing, McMaster University, Ontario, Canada
| | - Sophie Morris
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Andrew Harding
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Emily Cousins
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Karen Harrison Dening
- School of Nursing and Midwifery, De Montfort University, Leicester, UK; Dementia UK , London, UK
| | - Kay De Vries
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; Department of Primary and Community Care, Radboud uNiversity Medical Center, Nijmegen, The Netherlands.
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Dening KH. Dementia is everybody's business: a call for issues, learning needs and case studies. Br J Community Nurs 2022; 27:60-62. [PMID: 35137622 DOI: 10.12968/bjcn.2022.27.2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Bamford C, Wheatley A, Brunskill G, Booi L, Allan L, Banerjee S, Harrison Dening K, Manthorpe J, Robinson L. Key components of post-diagnostic support for people with dementia and their carers: A qualitative study. PLoS One 2021; 16:e0260506. [PMID: 34928972 PMCID: PMC8687564 DOI: 10.1371/journal.pone.0260506] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There has been a shift in focus of international dementia policies from improving diagnostic rates to enhancing the post-diagnostic support provided to people with dementia and their carers. There is, however, little agreement over what constitutes good post-diagnostic support. This study aimed to identify the components of post-diagnostic dementia support. METHODS We adopted a qualitative design using interviews, focus groups and observation to explore the perspectives of key stakeholders on the content of post-diagnostic dementia support. Purposive sampling was used to identify sites in England and Wales recognised as delivering good practice. Participants included 17 people with dementia, 31 carers, 68 service managers or funders, and 78 frontline staff. Interviews and focus groups were audio recorded and transcribed for analysis. Forty-eight sessions of observation were completed and recorded in fieldnotes. Components were identified through an inductive, thematic approach and cross-checked against national guidelines and existing frameworks; they were subsequently critically reviewed by a range of experts and our mixed stakeholder panel. RESULTS Twenty distinct components of post-diagnostic support were identified, related to five themes: timely identification and management of needs; understanding and managing dementia; emotional and psychological wellbeing; practical support; and integrating support. The first and last of these were cross-cutting themes facilitating the delivery of a unique constellation of components of post-diagnostic support to each individual living with dementia or dyad at a particular time. CONCLUSIONS Our work offers an empirically based framework to inform the development and delivery of holistic, integrated and continuous dementia care from diagnosis to end of life. It highlights the relevance of many components to both people living with dementia and their carers. Since the framework was developed in England and Wales, further research is needed to explore the relevance of our components to other sectors, countries and care systems.
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Affiliation(s)
- Claire Bamford
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alison Wheatley
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Greta Brunskill
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Laura Booi
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Louise Allan
- South Cloisters, University of Exeter, Exeter, United Kingdom
| | - Sube Banerjee
- Office of Vice Chancellor, University of Plymouth, Plymouth, United Kingdom
| | | | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute at King’s, King’s College London, London, United Kingdom
| | - Louise Robinson
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
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Cousins E, de Vries K, Harrison Dening K. ' Four walls and a garden': Exploring the experiences of families affected by dementia during the COVID-19 pandemic. Dementia (London) 2021; 21:810-829. [PMID: 34918956 PMCID: PMC8995930 DOI: 10.1177/14713012211059021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 12/02/2022]
Abstract
Introduction When the first national COVID-19 lockdown came into effect in the UK in March
2020, life changed significantly. Some services and social contacts for
people with dementia and their families stopped, while others, for example,
peer support, moved online. This research explored the experiences of
families affected by dementia during the pandemic, specifically those living
in the community. Aims In partnership with a community dementia charity, this study sought to gain
an understanding of the experiences of people with dementia and family
carers during the COVID-19 pandemic and explore the impact and implications
of lockdown on people with dementia and family carers. Methods This was a qualitative study that used semi-structured interviews to collect
data from people with dementia and family carers. Interviews were conducted
online via video call, individually or within caring dyads. Initially, data
were coded, analysed and themed inductively. Additionally, social disruption
and social division theories were used to deductively identify patterns in
the data to enhance understanding. Findings Six distinct themes were identified from the inductive analysis: Routine:
‘busy life before lockdown’; Isolation: ‘four
walls and a garden’; Living with restrictions:
‘treading on eggshells’; Discovering positives:
‘you are in the same boat’; Easing lockdown:
‘raring to go’; Heightened uncertainty: ‘things
have changed’. Illustrative examples of symptoms of social
disruption and division were identified within the data: frustration,
democratic disconnection, fragmentation, polarisation and escalation. Conclusion Experiences of people with dementia and family carers during the pandemic
were mixed, resulting in hopes and worries for the future. Social disruption
and social division are relevant frameworks for analysing experiences of
COVID-19.
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Affiliation(s)
- Emily Cousins
- Faculty of Health and Life Sciences, School of Nursing and Midwifery, RinggoldID:4487De Montfort University, Leicester, UK
| | - Kay de Vries
- Faculty of Health and Life Sciences, School of Nursing and Midwifery, RinggoldID:4487De Montfort University, Leicester, UK
| | - Karen Harrison Dening
- Faculty of Health and Life Sciences, School of Nursing and Midwifery, 4487De Montfort University, Leicester, UK; Dementia UK, London, UK
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Wheatley A, Bamford C, Brunskill G, Booi L, Dening KH, Robinson L. Implementing post-diagnostic support for people living with dementia in England: a qualitative study of barriers and strategies used to address these in practice. Age Ageing 2021; 50:2230-2237. [PMID: 34240114 PMCID: PMC8675435 DOI: 10.1093/ageing/afab114] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND inequalities and gaps in post-diagnostic support (PDS) for people with dementia persist despite a policy focus on dementia in England and Wales. Understanding and overcoming the factors contributing to these inequalities is vital to improve care for people living with dementia (PLWD) and their families. OBJECTIVE to explore common barriers to the delivery of PDS in England and Wales and describe successful strategies to address them, drawing on examples from current practice. DESIGN qualitative semi-structured interviews, focus groups and observation. SETTINGS Phase 1: interviewees were drawn from multiple sectors across England and Wales, including NHS clinical commissioning groups and social care. Phase 2: six case study sites based in different sectors (primary care, secondary mental health and third sector) in England. PARTICIPANTS Phase 1: 61 professionals, including commissioners and service managers. Phase 2: 68 professionals, including frontline staff and those working in related services; 17 PLWD; 31 carers. RESULTS barriers to implementing PDS in dementia were an unsupportive infrastructure, limited proactive review and limited capacity and capability particularly in primary care. Strategies used successfully in practice to address these challenges included creating opportunities for service development, improving joint working, supporting non-specialists and developing ongoing, holistic review and care planning. CONCLUSION a range of practical strategies have been identified to address many of the common barriers to PDS in dementia. To achieve policy goals of a task-shifted and task-shared approach to PDS, widespread use of these strategies is recommended.
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Affiliation(s)
- Alison Wheatley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Brunskill
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Booi
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Harrison Dening
- Health & Life Sciences, School of Nursing and Midwifery, De Montfort University, Leicester, UK
- Research & Publications, Dementia UK, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Davies N, Sampson EL, West E, DeSouza T, Manthorpe J, Moore K, Walters K, Dening KH, Ward J, Rait G. A decision aid to support family carers of people living with dementia towards the end-of-life: Coproduction process, outcome and reflections. Health Expect 2021; 24:1677-1691. [PMID: 34288291 PMCID: PMC8483186 DOI: 10.1111/hex.13307] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/17/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Family carers of people living with dementia often need support with making decisions about care. Many find end-of-life care decisions particularly difficult. The aim of this article is to present an evidence- and theoretical-based process for developing a decision aid to support family carers of people with dementia towards the end-of-life. METHODS Following a systematic process, we developed a decision aid using coproduction methods and matrices to synthesize data from a systematic review and qualitative interviews with people living with dementia and family carers. Data were presented to coproduction workshops of people living with dementia, family carers, practitioners and professionals. Development was guided by the Ottawa Decision Support Framework and a modified Interprofessional Shared Decision-Making model. RESULTS The decision aid covers four decision areas: (1) changes in care; (2) eating and drinking difficulties; (3) everyday well-being; and (4) healthcare, tests and medication. We present an interactive decision aid, using a variety of approaches including written text, Frequently Asked Questions, top tips and illustrative quotes from people living with dementia and family carers. CONCLUSION This is the first decision aid that focusses on multiple decisions towards the end-of-life in dementia care. The process offers a template for others to develop decision aids or similar interventions, and how to include people living with dementia in coproduction. PATIENT OR PUBLIC CONTRIBUTION Family carers provided feedback on data collection, data analysis and the decision aid, and one is a coauthor. People living with dementia and family carers were integral to the coproduction workshops.
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Affiliation(s)
- Nathan Davies
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- Barnet, Enfield and Haringey Mental Health Trust, Liaison Psychiatry TeamNorth Middlesex University HospitalLondonUK
| | - Emily West
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Tanisha DeSouza
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, Policy Institute at King'sKing's College LondonLondonUK
- NIHR Applied Research Collaborative (ARC) South LondonKing's College LondonLondonUK
| | - Kirsten Moore
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- National Ageing Research InstituteParkvilleVictoriaAustralia
| | - Kate Walters
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
| | | | - Jane Ward
- Family Carer, Member of Experts by Experience Panel
| | - Greta Rait
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
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Harding A, Preston N, Doherty J, Cousins E, Varey S, McCann A, Dening KH, Finucane A, Carter G, Mitchell G, Brazil K. Developing and evaluating online COVID-centric advance care planning training and information resources for nursing staff and family members in nursing homes: the necessary discussions study protocol. BMC Geriatr 2021; 21:456. [PMID: 34372794 PMCID: PMC8350283 DOI: 10.1186/s12877-021-02398-1] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Nursing home residents are typically older adults with high levels of chronic illness and impairment. As such, they are particularly susceptible to severe complications and mortality from COVID-19. Since all nursing home residents are at increased risk, nursing home care staff need to know what residents would want to happen should they become infected with COVID-19. This study aims to develop and evaluate advance care planning (ACP) COVID-centric online training and information resources for nursing home staff and family members of residents, to improve care at the end of life during a COVID-19 outbreak. Based on the findings we will develop implementation guidelines for nursing homes to ensure wider impact and application during the pandemic and beyond. Methods The content of the training and information resources will be based on a rapid review of literature and guidance on ACP in the context of COVID-19 and consultation with the study expert reference group. An integrated communications company will then work alongside the research team to design the online training and information resources. To evaluate the resources, we will employ a multiple case study design where a nursing home (defined as an institutional setting in which nursing care is provided to older adults on-site 24 h a day) will be the unit of analysis or ‘case’. The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will guide the evaluation of implementation of the training and information resources. We will recruit and interview staff and family members from between 6 and 9 nursing homes across Northern Ireland, England and Scotland and gather quantitative data from a feedback survey included in the training and information resources. Discussion The Necessary Discussions study is very timely given the challenging experiences of nursing homes, their staff, residents and their family members during the COVID-19 pandemic. It meets a key need and addresses an important gap in research and practice. The training and information resources will be ‘COVID-centric’, but they will also have a longstanding relevance for future ACP practice in UK care homes. Trial registration ISRCTN registry (ID 18003630) on 19.05.21
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Affiliation(s)
- Andrew Harding
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Julie Doherty
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Emily Cousins
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sandra Varey
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Adrienne McCann
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Karen Harrison Dening
- School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester & Dementia UK, London, UK
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh & Marie Curie Hospice Edinburgh, Edinburgh, UK
| | - Gillian Carter
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Gary Mitchell
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK.
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Frost R, Rait G, Aw S, Brunskill G, Wilcock J, Robinson L, Knapp M, Hogan N, Harrison Dening K, Allan L, Manthorpe J, Walters K. Implementing post diagnostic dementia care in primary care: a mixed-methods systematic review. Aging Ment Health 2021; 25:1381-1394. [PMID: 32911966 DOI: 10.1080/13607863.2020.1818182] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Concentrating post-diagnostic dementia care in primary care may lead to better and more cost-effective care closer to home. We aimed to assess which intervention components and contextual factors may contribute to the successful delivery and implementation of primary care-led post-diagnostic dementia care. METHODS Mixed-methods systematic review. We searched five databases (inception-March 2019) with reference list screening and citation tracking. We included studies evaluating post-diagnostic dementia care interventions where primary care had a significant role in dementia care, which assessed one or more implementation elements (acceptability, feasibility, adoption, sustainability, reach, costs, appropriateness or fidelity). Two authors independently critically appraised studies. RESULTS Out of 4528 unique references, we screened 380 full texts and included 49 evaluations of services collecting implementation process data. Most services had high acceptability ratings. The most acceptable components were information provision, social and emotional support and links to community organisations. Feasibility was chiefly influenced by provider engagement and leadership, building dementia care capacity, sufficient resources/funding and collaboration. Care quality was maximised through adding capacity from a dementia-specific health professional. On the basis of limited data, costs for various primary care-led models did not substantially differ from each other. CONCLUSION A range of primary care-led dementia care models appear feasible and acceptable. Future services should: add dementia-focussed health professionals into primary care, develop primary care leadership and provide sufficient funding and collaboration opportunities. Information, community service links and social and ongoing support should be part of services. Further exploration of service reach and formalised fidelity assessment are needed.
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Affiliation(s)
- Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Su Aw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Greta Brunskill
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Martin Knapp
- 4Care Policy and Evaluation Centre (CPEC), Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Nicole Hogan
- 4Care Policy and Evaluation Centre (CPEC), Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Louise Allan
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit on Health and Social Care Workforce, Kings College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
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De Vries K, Cousins E, Harrison Dening K. Palliative care in Creutzfeldt-Jakob disease: looking back, thinking ahead. BMJ Support Palliat Care 2021:bmjspcare-2020-002799. [PMID: 33483321 DOI: 10.1136/bmjspcare-2020-002799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/11/2020] [Accepted: 12/23/2020] [Indexed: 11/03/2022]
Abstract
Creutzfeldt-Jakob disease (CJD) is a rare and fatal neurodegenerative disease for which there is no cure. However, it is difficult to diagnose and is unique in that it is both a genetic and transmissible disease. The disease is characterised by symptoms of a rapidly progressive dementia. Palliation is the only treatment and early diagnosis is an important aspect in relation to gaining speedy access to palliative and end-of-life care services. People with CJD may be cared for in a diversity of settings including; general hospital wards, neurological units, hospices; care homes and in their own home. Management of physical and psychosocial symptoms and dealing with family bereavement is complex and challenging. Due to the complexity of the physical symptoms input from clinicians with palliative care expertise is an important consideration. Given transmission risk and the latent incidence of infection in the general population, following the emergence of variant CJD; plus the recent hypothesis of a potential relationship between immune responses to COVID-19 and the acceleration of preclinical or evident neurodegenerative disease, there is a need for renewed interest in research in this field. Over the past 20 years, many thousands of articles have been published on CJD. These have been predominately in the medical and science literature and very few publications have addressed the nursing care of persons and families dealing with CJD. There is a need for renewed interest in the management of the disease by supportive and palliative care services.
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Affiliation(s)
- Kay De Vries
- Faculty Health & Life Sciences, De Montfort University, Leicester, UK
| | - Emily Cousins
- Faculty Health & Life Sciences, De Montfort University, Leicester, UK
| | - Karen Harrison Dening
- Research & Publications, Dementia UK, London, UK
- De Montfort University, Leicester, UK
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Aldridge Z, Oliver E, Gardener H, Dening KH. Admiral Nursing-A Model of Specialist Dementia Care in Acute Hospitals. SAGE Open Nurs 2021; 6:2377960820952677. [PMID: 33415301 PMCID: PMC7774376 DOI: 10.1177/2377960820952677] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/26/2020] [Accepted: 08/02/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction The rising prevalence of dementia has led to increased numbers of people with
dementia being admitted to acute hospitals. This demand is set to continue
due to an increasingly older population who are likely to have higher levels
of dependency, dementia, and comorbidity. If admitted to the hospital,
people with dementia are at higher risk of poor outcomes during and
following a hospital admission. Yet, there remains a significant lack of
specialist support within acute hospitals to support people with dementia,
their families and hospital staff. Methods Admiral Nurses are specialists that work with families affected by dementia
and provide consultancy and support to health and social care colleagues to
improve the delivery of evidenced based dementia care. Historically, Admiral
Nurses have predominantly been based in community settings. In response to
the increasing fragmentation of services across the dementia trajectory, the
Admiral Nurse model is evolving and adapting to meet the complex needs of
families impacted upon by dementia inclusive of acute hospital care. Results The Admiral Nurse acute hospital model provides specialist interventions
which improve staff confidence and competence and enables positive change by
improving skills and knowledge in the provision of person-centred dementia
care. The role has the capacity to address some of the barriers to
delivering person centred dementia care in the acute hospital and contribute
to improvements across the hospital both as a result of direct interventions
or influencing the practice of others. Conclusion Improving services for people with dementia and their families requires a
whole system approach to enable care coordination and service integration,
this must include acute hospital care. The increasing numbers of people with
dementia in hospitals, and the detrimental effects of admission, make
providing equitable, consistent, safe, quality care and support to people
with dementia and their families a national priority requiring immediate
investment. The inclusion of Admiral Nursing within acute hospital services
supports service and quality improvement which positively impacts upon the
experience and outcomes for families affected by dementia.
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Affiliation(s)
- Zena Aldridge
- Dementia UK, London, UK.,Health and Life Sciences, De Montfort University, Leicester, UK
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Abstract
The COVID-19 pandemic has had a devastating impact on care homes in the United Kingdom, particularly for those residents living with dementia. The impetus for this article comes from a recent review conducted by the authors. That review, a qualitative media analysis of news and academic articles published during the first few months of the outbreak, identified ethical care as a key theme warranting further investigation within the context of the crisis. To explore ethical care further, a set of salient ethical values for delivering care to care home residents living with dementia during the pandemic was derived from a synthesis of relevant ethical standards, codes and philosophical approaches. The ethical values identified were caring, non-maleficence, beneficence, procedural justice, dignity in death and dying, well-being, safety, and personhood. Using these ethical values as a framework, alongside examples from contemporaneous media and academic sources, this article discusses the delivery of ethical care to care home residents with dementia within the context of COVID-19. The analysis identifies positive examples of ethical values displayed by care home staff, care sector organisations, healthcare professionals and third sector advocacy organisations. However, concerns relating to the death rates, dignity, safety, well-being and personhood - of residents and staff - are also evident. These shortcomings are attributable to negligent government strategy, which resulted in delayed guidance, lack of resources and Personal Protective Equipment, unclear data, and inconsistent testing. Consequently, this review demonstrates the ways in which care homes are underfunded, under resourced and undervalued.
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Frost R, Rait G, Wheatley A, Wilcock J, Robinson L, Harrison Dening K, Allan L, Banerjee S, Manthorpe J, Walters K. What works in managing complex conditions in older people in primary and community care? A state-of-the-art review. Health Soc Care Community 2020; 28:1915-1927. [PMID: 32671922 DOI: 10.1111/hsc.13085] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
The number of older people living with complex health conditions is increasing, with the majority of these managed in primary and community settings. Many models of care have been developed to support them, however, there is mixed evidence on their value and they include multiple overlapping components. We aimed to synthesise the evidence to learn what works for managing complex conditions in older people in primary and community care. We carried out a state-of-the-art review of systematic reviews. We searched three databases (January 2009 to July 2019) for models of primary and community care for long-term conditions, frailty, multimorbidity and complex neurological conditions common to older people such as dementia. We narratively synthesised review findings to summarise the evidence for each model type and identify components which influenced effectiveness. Out of 2,129 unique titles and abstracts, 178 full texts were reviewed and 54 systematic reviews were included. We found that the models of care were more likely to improve depressive symptoms and mental health outcomes than physical health or service use outcomes. Interventions including self-management, patient education, assessment with follow-up care procedures, and structured care processes or pathways had greater evidence of effectiveness. The level of healthcare service integration appeared to be more important than inclusion of specific professional types within a team. However, more experienced and qualified nurses were associated with better outcomes. These conclusions are limited by the overlap between reviews, reliance on vote counting within some included reviews and the quality of study reports. In conclusion, primary and community care interventions for complex conditions in older people should include: (a) clear intervention targets; (b) explicit theoretical underpinnings; and (c) elements of self-management and patient education, structured collaboration between healthcare professionals and professional support. Further work needs to determine the optimal intensity, length, team composition and role of technology in interventions.
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Affiliation(s)
- Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Alison Wheatley
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Louise Allan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jill Manthorpe
- NIHR Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
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Affiliation(s)
| | - Mari Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group, Primary Care and Mental Health, Liverpool, UK
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Brown P, Oliver E, Dening KH. Supporting family carers via the Admiral Nurse Dementia Helpline: reflection on a case study. Nurs Older People 2020; 32:16-20. [PMID: 32400141 DOI: 10.7748/nop.2020.e1248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2020] [Indexed: 06/11/2023]
Abstract
In the UK, the quality of post-diagnostic care and support for people with dementia and their family carers is variable and depends on the availability of services in each person's local area. This article considers the support services available for families affected by dementia and discusses how telephone helplines can assist those who may have no access to other types of support. It presents a case study describing a call to the Admiral Nurse Dementia Helpline, a service run by nurses with expertise in dementia care and provided by the charity Dementia UK. This is followed by a reflection on the call from the nurse's perspective. The case study-based reflection demonstrates the complexity of providing support through a helpline and the specialist knowledge and skills required to provide the appropriate level of support.
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Wheatley A, Bamford C, Brunskill G, Harrison Dening K, Allan L, Rait G, Robinson L. Task-shifted approaches to postdiagnostic dementia support: a qualitative study exploring professional views and experiences. BMJ Open 2020; 10:e040348. [PMID: 32958494 PMCID: PMC7507844 DOI: 10.1136/bmjopen-2020-040348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To explore the views of commissioners, service development leads, service managers and senior staff in selected dementia services on increasing the role of primary care in postdiagnostic support for people with dementia. DESIGN Qualitative semi-structured telephone interviews and a focus group. SETTING Participants were drawn from National Health Service (NHS) Clinical Commissioning Groups, social care commissioning and a range of dementia services across primary care, secondary mental healthcare, social care and the third sector. All participants were based in England or Wales. PARTICIPANTS 61 professionals, comprising 25 commissioners or service development leads; 25 service managers; and 11 team leads or senior staff. RESULTS Participants had varied views on whether a primary care-based approach for postdiagnostic support for people with dementia and their families was appropriate, achievable and/or desirable. Potential benefits of a task-shifted approach were continuity and a more holistic approach to care; familiarity for both patients and staff; and reduction of stigma. Key challenges included the capacity, ability and inclination of primary care to deliver postdiagnostic support for people with dementia and their families. We discovered a number of conceptual challenges to implementing a task-shifted and task-shared approach, including uncertainties around the nature of postdiagnostic support, the definition of primary care and identification of tasks that could be shifted to primary care. CONCLUSIONS Our data highlight the concerns of key professional staff around greater involvement of primary care in postdiagnostic support for dementia. Further research is needed to achieve a shared understanding and consensus over what postdiagnostic support means in the context of dementia. We will be undertaking such research in the next phase of our programme.
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Affiliation(s)
- Alison Wheatley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Brunskill
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Harrison Dening
- Health & Life Sciences, School of Nursing and Midwifery, De Montfort University, Leicester, UK
- Research & Publications, Dementia UK, London, UK
| | - Louise Allan
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Mountford W, Dening KH, Green J. Advance care planning and decision-making in dementia care: a literature review. Nurs Older People 2020:e1238. [PMID: 32666719 DOI: 10.7748/nop.2020.e1238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
Dementia is the leading cause of death in England and Wales, but traditionally it has not been considered a terminal or life-limiting condition. As a result, little significance may be placed on advance care planning (ACP) for people with dementia. Evidence suggests that most patients with advanced dementia have often not been given an opportunity to complete an advance care plan and have not had conversations with their families about their wishes and preferences at the end of life. This article reports on a literature review that aimed to explore the evidence on the introduction of ACP in achieving preferred place of care or death for people living with dementia, and reducing carer burden. The literature review found that ACP discussions have several benefits for people with dementia and their family carers, but that various factors can support or hinder such discussions. It concludes that these people and their families need to plan for end of life and suggests that ACP can increase the likelihood of achieving their preferred place of care and death and reducing decisional burden for carers.
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Frost R, Walters K, Wilcock J, Robinson L, Harrison Dening K, Knapp M, Allan L, Rait G. Mapping post-diagnostic dementia care in England: an e-survey. JICA 2020. [DOI: 10.1108/jica-02-2020-0005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PurposePost-diagnostic dementia care is often fragmented in the United Kingdom, with great variation in provision. Recent policies suggest moving towards better community-based care for dementia; however, little is known on how this care is delivered. This study aimed to map the post-diagnostic dementia support provided in England a decade after the introduction of a National Dementia Strategy.Design/methodology/approachA mixed-methods e-survey (open Nov 2018–Mar 2019) of dementia commissioners in England recruited through mailing lists of relevant organisations was conducted. The authors descriptively summarised quantitative data and carried out thematic analysis of open-ended survey responses.Findings52 completed responses were received, which covered 82 commissioning bodies, with representation from each region in England. Respondents reported great variation in the types of services provided. Information, caregiver assessments and dementia navigation were commonly reported and usually delivered by the voluntary sector or local authorities. Integrated pathways of care were seen as important to avoid overlap or gaps in service coverage. Despite an increasingly diverse population, few areas reported providing dementia health services specifically for BME populations. Over half of providers planned to change services further within five years.Practical implicationsThere is a need for greater availability of and consistency in services in post-diagnostic dementia care across England.Originality/valuePost-diagnostic dementia care remains fragmented and provided by a wide range of providers in England.
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Weatherhead I, Eades L, Harrison Dening K, Weidner W. Admiral Nurses delivering workplace clinics for family carers: Innovative practice. Dementia 2020; 19:472-478. [DOI: 10.1177/1471301217705547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dementia UK and The Charity for Civil Servants teamed up to test the acceptability and feasibility of delivering a work-based Admiral Nurse clinic to support family carers during their employed working hours. This paper presents some of the learning from this innovative approach.
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Harrison Dening K. Frailty leads to higher mortality and hospital use. Evid Based Nurs 2020; 24:13. [PMID: 31932353 DOI: 10.1136/ebnurs-2019-103228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2019] [Indexed: 11/03/2022]
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Abstract
Older people can find hospital stays challenging and distressing. When their presenting symptoms make it challenging for healthcare professionals to differentiate between dementia, delirium and depression, their experience may be increasingly distressing, and can result in delays in diagnosis and treatment, as well as an increased risk of morbidity. This article considers each of the conditions of dementia, delirium and depression, their presenting features and how nurses can differentiate between them to enable comprehensive assessment, diagnosis and treatment in older people.
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Abstract
The majority of patients are diagnosed within a memory assessment service or a neurology clinic. However, early detection of a possible dementia is often done in a primary care setting. Dementia diagnosis has been seen by some as a 'tick-box exercise' but there are significant benefits to patients and their families when screening or testing for dementia is carried out early, especially in supporting the patients management of other comorbid or long-term conditions. Community nurses have a key role in identifying patients who may have the signs and symptoms of dementia by enabling them to access a timely diagnosis.
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Harrison Dening K, Scates C, McGill G, De-Vries K. A training needs analysis of admiral nurses to facilitate advance care planning in dementia. Palliat Care 2019; 12:1178224219850183. [PMID: 31258328 PMCID: PMC6585248 DOI: 10.1177/1178224219850183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/20/2019] [Accepted: 04/04/2019] [Indexed: 11/15/2022] Open
Abstract
Education of health and social care professionals is essential in preparation to confidently and effectively support families affected by dementia to undertake advance care planning. This article describes a training needs analysis of Admiral Nurses, dementia specialists, in facilitating advance care planning for future care. METHODS A questionnaire survey was completed by Admiral Nurses attending end-of-life care masterclasses in 2017 and 2018. Both quantitative (years registered as a nurse, years as an Admiral Nurse and subjective level of confidence in completing advance care plannings) and qualitative data (interventions perceived to increase confidence) were collected. FINDINGS There were 75 completed responses (two incomplete returns). There was no correlation between levels of confidence and years registered as a nurse. However, there was a small positive correlation between confidence and number of years as an Admiral Nurse (r = 0.23; p < 0.05). Themes identified qualitatively to enhance practice were advanced communication skills, supervised practice, resources to frame conversations and a guide and template for advance care planning. CONCLUSION Although Admiral Nurses are specialists in dementia, several educational initiatives could be employed to better enable them to support advance care planning for families affected by dementia. This training needs analysis is contributed towards developing an educational intervention for Admiral Nurses to improve advance care planning support.
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Affiliation(s)
- Karen Harrison Dening
- Dementia UK, London, UK; Faculty of Health and Life Sciences, School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | | | | | - Kay De-Vries
- Faculty of Health and Life Sciences, School of Nursing and Midwifery, De Montfort University, Leicester, UK
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Lovadini GB, Fukushima FB, Schoueri JFL, dos Reis R, Fonseca CGF, Rodriguez JJC, Coelho CS, Neves AF, Rodrigues AM, Marques MA, Jacinto AF, Harrison Dening K, Bassett R, Moss AH, Steinberg KE, Vidal EIDO. Evaluation of the Interrater Reliability of End-of-Life Medical Orders in the Physician Orders for Life-Sustaining Treatment Form. JAMA Netw Open 2019; 2:e192036. [PMID: 30977852 PMCID: PMC6481595 DOI: 10.1001/jamanetworkopen.2019.2036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite its spread in much of the United States and increased international interest, the Physician Orders for Life-Sustaining Treatment (POLST) paradigm still lacks supporting evidence. The interrater reliability of the POLST form to translate patients' values and preferences into medical orders for care at the end of life remains to be studied. OBJECTIVE To assess the interrater reliability of the medical orders documented in POLST forms. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted in a public university hospital in southeastern Brazil. Two independent researchers interviewed the same patients or decision-making surrogates (n = 64) during a single episode of hospitalization within a time frame of 1 to 7 days. Eligible participants were hospitalized adults aged 21 years or older who were expected to remain hospitalized for at least 4 days and whose attending physician responded no to the question, Would I be surprised if this patient died in the next year? Data collection occurred between November 1, 2015, and September 20, 2016, and first data analyses were performed on October 3, 2016. MAIN OUTCOMES AND MEASURES Interrater reliability as measured by κ statistics. RESULTS Of the 64 participants interviewed in the study, 53 (83%) were patients and 11 (17%) were surrogates. Patients' mean (SD) age was 64 (14) years, and 35 patients (55%) and 8 surrogates (73%) were women. Overall, in 5 cases (8%), disagreement in at least 1 medical order for life-sustaining treatment was found in the POLST form, changing from the first interview to the second interview. The κ statistic for cardiopulmonary resuscitation was 0.92 (95% CI, 0.80-1.00); for level of medical intervention, 0.89 (95% CI, 0.76-1.00); and for artificially administered nutrition, 0.92 (95% CI, 0.83-1.00). CONCLUSIONS AND RELEVANCE The high interrater reliability of the medical orders in POLST forms appears to offer further support for this advance care planning paradigm; in addition, the finding that this interrater reliability was not 100% underscores the need to ensure that patients or their surrogates have decision-making capacity and to confirm that the content of POLST forms accurately reflects patients' current treatment preferences.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Rick Bassett
- Center for Nursing Excellence, St Luke’s Health System, Kansas City, Missouri
| | - Alvin H. Moss
- Center for Health Ethics and Law, West Virginia University, Morgantown
| | - Karl E. Steinberg
- Institute for Palliative Care, California State University, Long Beach
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de Vries K, Banister E, Dening KH, Ochieng B. Advance care planning for older people: The influence of ethnicity, religiosity, spirituality and health literacy. Nurs Ethics 2019; 26:1946-1954. [PMID: 30943848 DOI: 10.1177/0969733019833130] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 12/30/2022]
Abstract
In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples' ability to enact moral agency in making such decisions.
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Aldridge Z, Burns A, Harrison Dening K. ABC model: A tiered, integrated pathway approach to peri- and post-diagnostic support for families living with dementia (Innovative Practice). Dementia (London) 2019; 19:2901-2910. [PMID: 30909717 DOI: 10.1177/1471301219838086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/15/2022]
Abstract
Services for people with dementia and their families in England are commissioned with a lack of integration and an inconsistent approach creating gaps in service provision. Therefore, families affected by dementia are not receiving the appropriate care in a timely manner and often access support at crisis point. This reactive and crisis driven approach to care is costly financially and can have a negative impact and quality of life of those affected. The ABC model offers an adaptable framework that can inform service provision and improve opportunities to create seamless peri- and post-diagnosis dementia services for families affected by dementia.
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Harrison Dening K, Sampson EL, De Vries K. Advance care planning in dementia: recommendations for healthcare professionals. Palliat Care 2019; 12:1178224219826579. [PMID: 30833812 PMCID: PMC6393818 DOI: 10.1177/1178224219826579] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [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: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/17/2022] Open
Abstract
The process of advance care planning in dementia is far from straightforward; as dementia progresses, the ability to consider future thoughts and actions becomes compromised, thus affecting decision-making abilities. Family carers find themselves increasingly in a position where they need to inform, or directly make, decisions on behalf of the person with dementia. This article discusses the context and importance of a palliative care approach and recommends rationales and strategies for healthcare professionals to support families affected by dementia to better plan for their future care.
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Affiliation(s)
- Karen Harrison Dening
- Research & Publications, Dementia UK, London, UK; School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Elizabeth L Sampson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Kay De Vries
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
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Harrison Dening K, Castle E, Scates C, De Vries K. Advance care plans in dementia: user-centred design. BMJ Support Palliat Care 2019; 10:e38. [PMID: 30737197 DOI: 10.1136/bmjspcare-2018-001700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/26/2018] [Revised: 01/09/2019] [Accepted: 01/23/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Historically, dementia has not been recognised as a life-limiting condition or one that may benefit from a palliative approach to its care. There are many challenges in providing palliative and end-of-life care to this group of people, some of which may be reduced through advance care planning (ACP) to support people with dementia to have a greater influence on their care at end of life. ACP has been defined as a process of discussing and recording of wishes, values and preferences for future care and treatment held between an individual, family members and their care provider(s) that takes effect when the person loses capacity. The objective of this project was to involve people with dementia and their family carers in co-design of ACP guide and template to prepare for further study related to communication processes in ACP. METHODS A user-centred design process cycle of development and review was undertaken by Dementia UK which involved people with dementia, family carers, Admiral Nurses and other key stakeholders in developing an ACP guide and template. RESULTS Nine cyclical stages were undertaken to achieve the outcome of an ACP guide and template. CONCLUSION Co-production using a user-centred design approach offers a structured and inclusive approach to developing ACP materials.Authors.
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Affiliation(s)
| | - Emma Castle
- Research and Publications, Dementia UK, London, UK
| | | | - Kay De Vries
- Health and Life Sciences, School of Nursing and Midwifery, The Gateway, De Montfort University, Leicester, UK
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