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Sturge J, Janus S, Zuidema S, Frederiks B, Schweda M, Landeweer E. The Moral and Gender Implications of Measures Used to Modulate the Mobility of People With Dementia Living in Residential Care Environments: A Scoping Review. Gerontologist 2024; 64:gnad071. [PMID: 37330640 PMCID: PMC10943503 DOI: 10.1093/geront/gnad071] [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: 10/28/2022] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Policies and measures often restrict the mobility of people with dementia living in residential care environments to protect them from harm. However, such measures can violate human rights and affect the quality of life. This review aims to summarize the literature on what is known about measures used to modulate the life-space mobility of residents with dementia living in a residential care environment. Furthermore, moral and sex and gender considerations were explored. RESEARCH DESIGN AND METHODS A scoping review framework was referenced to summarize the literature. A total of 5 databases were searched: PubMed, Embase, CINAHL, SCOPUS, and Web of Science. The studies for eligibility using the Rayyan screening tool. RESULTS A total of 30 articles met the inclusion criteria. A narrative description of the findings of the articles is presented across 3 themes: (1) measures and strategies used to modulate the life-space mobility; (2) moral aspects; and (3) sex and gender considerations. DISCUSSION AND IMPLICATIONS Various measures are used to modulate the life-space mobility of people with dementia living in residential care facilities. Research exploring the sex and gender differences of people with dementia is lacking. With a focus on human rights and quality of life, measures used to restrict or support mobility must support the diverse needs, capacity, and dignity of people with dementia. Noting the capacity and diversity of people with dementia will require society and public space to adopt strategies that promote safety and mobility to support the quality of life of people with dementia.
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Affiliation(s)
- Jodi Sturge
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Brenda Frederiks
- Department of Ethics, Law and Humanities, University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Mark Schweda
- Division of Ethics in Medicine, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Elleke Landeweer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Gitlin LN, Roth DL, Marx K, Parker LJ, Koeuth S, Dabelko-Schoeny H, Anderson K, Gaugler JE. Embedding Caregiver Support Within Adult Day Services: Outcomes of a Multisite Trial. Gerontologist 2024; 64:gnad107. [PMID: 37549428 PMCID: PMC10943495 DOI: 10.1093/geront/gnad107] [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: 02/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Adult day services (ADS) provide quality-of-life benefits to people with dementia, but few provide systematic caregiver support. We report outcomes of a multisite, national trial testing a staff-delivered caregiver program, ADS Plus. RESEARCH DESIGN AND METHODS Cluster-randomized trial involving 34 ADS: 18 sites provided ADS (controls) and 16 provided ADS and ADS Plus (intervention). Trained staff met with caregivers to provide dementia education, support/validation, referrals/linkages, and strategies for care challenges and self-care over 12 months. Main outcomes included depressive symptoms (Center for Epidemiological Studies Depression Scale [CES-D]) and well-being at 6 and 12 months, and client attendance over 12 months. RESULTS Of 203 caregivers (Intervention = 102; Control = 101), 5.9% at 3 months, 12.8% at 6 months, and 22.7% at 12 months were lost to follow-up. Caregivers were predominantly female (80.3%), with 76.4% identifying as White/Caucasian, 14.8% Black/African American, and 12.3% Hispanic/Latino. Most (88.2%) had ≥college education and were 65.0 years old (SD = 13.46). For those with 6-month data, 40.4% control and 40.2% ADS Plus caregivers had depressed symptoms (≥16 CES-D) at baseline. By 6 months, 43.6% control versus 34.2% ADS Plus caregivers had ≥16 scores (odds ratio = 0.38, p = .072). By 12 months, after covariate adjustments, ADS Plus caregivers reported reduced total depression scores versus controls (p = .013) and lower depressed affect scores (p = .015). Of 18 sites providing 12-month client attendance data, 9 intervention sites reported 126.05 days attended versus 78.49 days for 9 control sites (p = .079). DISCUSSION AND IMPLICATIONS Compared with ADS alone, by 12 months, ADS Plus improved caregiver mood and increased ADS utilization by 60.6%. Results support ADS staff delivering evidence-based caregiver support to enhance ADS benefits. CLINICAL TRIAL REGISTRATION NCT02927821.
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Affiliation(s)
- Laura N Gitlin
- AgeWell Collaboratory, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - David L Roth
- Center on Aging and Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine Marx
- Center for Equity in Aging, School of Nursing, John Hopkins University, Baltimore, Maryland, USA
| | - Lauren J Parker
- Department of Health, Behavior and Society, School of Public Health, Johns Hopkins Bloomberg, Baltimore, Maryland, USA
| | - Sokha Koeuth
- AgeWell Collaboratory, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Holly Dabelko-Schoeny
- Age-Friendly Innovation Center, College of Social Work, The Ohio State University, Columbus, Ohio, USA
| | - Keith Anderson
- Department of Social Work, School of Applied Sciences, University of Mississippi, Oxford, Mississippi, USA
| | - Joseph E Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Folder N, Power E, Rietdijk R, Christensen I, Togher L, Parker D. The Effectiveness and Characteristics of Communication Partner Training Programs for Families of People With Dementia: A Systematic Review. Gerontologist 2024; 64:gnad095. [PMID: 37439771 PMCID: PMC10949353 DOI: 10.1093/geront/gnad095] [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: 03/14/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Communication partner training (CPT) is essential in dementia care. Despite families being the largest group of community carers, previous reviews primarily focused on formal carers. This study aimed to understand the characteristics and effectiveness of CPT for families of people with dementia. RESEARCH DESIGN AND METHODS The systematic review included intervention/protocol studies on dementia CPT for families, excluding formal carers and programs not focused on communication. CINAHL, PsycINFO, SpeechBITE, Medline, SCOPUS, and Embase were searched between November 30 and December 6, 2021. After deduplication, 3,172 records were screened. Quality assessment used JBI Critical Appraisal tools and the Mixed Methods Appraisal Tool. Data synthesis utilized three reporting tools, the International Classification of Functioning, Disability, and Health, and content analysis. RESULTS Of 30 studies (27 programs), there were 10 quasi-experimental, 5 RCTs, 4 mixed methods, 4 case studies, 4 qualitative, and 2 protocols. Studies were published between 1998 and 2021 and included 671 family members. Characteristics varied with 7/27 programs including consumers during creation and one program including telehealth. One study included all reporting tool criteria. Programs typically used 4 intervention functions, with 12/27 programs addressing 3 behavior change areas. 33/74 outcome measures targeted the "Environment" of the person with dementia. Studies showed positive improvements in communication skills and knowledge, with mixed results on behavior/psychosocial outcomes. Qualitative results identified improvements in conversation and attitudes. DISCUSSION AND IMPLICATIONS CPT for families improves communication outcomes, however, quality of studies varied significantly. Future research should address gaps in telehealth, consumer involvement, and intervention descriptions.
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Affiliation(s)
- Naomi Folder
- Faculty of Health, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Emma Power
- Faculty of Health, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Glebe, New South Wales, Australia
| | - Iben Christensen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Hovedstaden, Denmark
| | - Leanne Togher
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Glebe, New South Wales, Australia
| | - Deborah Parker
- Faculty of Health, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Bashian HM, Boyle JT, Correa S, Driver J, Madrigal C, Desroches I, Farrell M, Eiten O, Flanagan K, Shahal T, O'Malley KA. Implementation of STAR-VA for behavioral symptoms of dementia in acute care: Lessons learned. Geriatr Nurs 2024; 57:17-22. [PMID: 38452494 DOI: 10.1016/j.gerinurse.2024.02.031] [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: 12/18/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
As the population grows, the incidence of dementia will increase. A common occurrence in people with dementia is behavioral and psychological symptoms of dementia (BPSD). BPSD can include apathy, aggression, resistance to care, and agitation. BPSD can start or worsen during an acute hospitalization, but these units are not well-equipped to handle BPSD, often relying on pharmacological interventions to address distress behaviors. One known behavioral intervention for BPSD is STAR-VA, an interdisciplinary approach to managing these behaviors. However, this intervention has not been utilized in acute care. Our team implemented STAR-VA in acute care at a Veterans Affairs hospital in the northeastern United States. Using the VA's Quality Enhancement Research Initiative (QUERI) implementation roadmap to guide our work, we first outlined the problem, completed a needs assessment with staff, and began implementation. Results from this quality improvement project demonstrated the feasibility and efficacy of STAR-VA in an acute care setting.
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Affiliation(s)
- Hannah M Bashian
- VA Boston Healthcare System, United States; Harvard Medical School, United States.
| | - Julia T Boyle
- VA Boston Healthcare System, United States; New England Geriatric Research Education and Clinical Center, United States; Harvard Medical School, United States
| | | | - Jane Driver
- VA Boston Healthcare System, United States; Harvard Medical School, United States
| | | | | | | | | | | | - Talya Shahal
- VA Boston Healthcare System, United States; Boston University Chobanian & Avedisian School of Medicine, United States; Harvard Medical School, United States
| | - Kelly A O'Malley
- VA Boston Healthcare System, United States; New England Geriatric Research Education and Clinical Center, United States; Harvard Medical School, United States
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Bradbury B, Chester H, Santer M, Morrison L, Fader M, Ward J, Manthorpe J, Murphy C. Healthcare professionals' experiences and views of providing continence support and advice to people living at home with dementia: "That's a carer's job". BMC Geriatr 2024; 24:213. [PMID: 38424477 PMCID: PMC10905774 DOI: 10.1186/s12877-024-04830-8] [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: 11/23/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND People living with dementia at home and their family carers often feel unsupported by healthcare professionals in managing continence problems. In turn, primary and community-based healthcare professionals have reported lacking specific knowledge on dementia-continence. This study aimed to understand more about healthcare professionals' experiences and views of supporting people living with dementia experiencing continence problems, as part of developing acceptable resources. Having a nuanced understanding of unmet need would facilitate the design of engaging resources that enable healthcare professionals to provide more effective continence support to people living with dementia at home. METHODS Semi-structured interviews were conducted with a range of healthcare professionals (n = 31) working in primary and community care in the South of England in 2023. Transcribed interviews were uploaded to NVivo 12, then analysed inductively and deductively using a thematic framework. RESULTS Continence-related conversations were avoided by many healthcare professionals due to lack of dementia-continence specific knowledge. Many considered that continence problems of people living with dementia were largely outside their remit once a physical cause had been ruled out. This contributed to a lack of priority and proactivity in raising the subject of continence in their consultations. Challenges to providing support included limited consultation time and lack of access to specialist services with availability to support individuals. CONCLUSION There is substantial scope to support primary and community-based healthcare professionals in their provision of continence-related support and advice to people living at home with dementia. This includes addressing knowledge deficits, enhancing confidence and instilling a sense of accomplishment.
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Affiliation(s)
- Barbara Bradbury
- School of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Shirley, SO16 6YD, UK.
| | - Helen Chester
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE, UK
| | - Miriam Santer
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education (PPM), Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Leanne Morrison
- Department of Psychology, Faculty of Environmental and Life Sciences, Primary Care Research Centre, Faculty of Medicine, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Mandy Fader
- University of Southampton, B67, West Highfield Campus, University Road, Southampton, SO17 1BJ, UK
| | - Jane Ward
- University of Southampton, B67, West Highfield Campus, University Road, Southampton, SO17 1BJ, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE, UK
| | - Catherine Murphy
- School of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Shirley, SO16 6YD, UK
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Sy M, Thacker A, Sheehan OC, Leff B, Ritchie CS. Caring for caregivers and persons living with dementia under home-based primary care: protocol for an interventional clinical trial. Pilot Feasibility Stud 2024; 10:28. [PMID: 38336779 PMCID: PMC10854016 DOI: 10.1186/s40814-024-01455-x] [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: 07/24/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Approximately 7.5 million older adults are homebound, who have difficulty and/or need assistance to leave their homes. In this growing population, the prevalence of people living with dementia (PLWD) is approximately 50%. Current dementia care models in the USA were developed for traditional office-based primary care and have not been tailored to home-based primary care (HBPC) delivery models. Literature has shown that office-based collaborative interventions can improve caregiver outcomes including caregiver stress, well-being, and morbidity and patient outcomes including improved quality of life and reduced emergency department visits (Possin KL, Merrilees JJ, Dulaney S, Bonasera SJ, Chiong W, Lee K, JAMA Int Med 179:1658, 2019). To date, the evidence for HBPC dementia interventions is lacking. Though HBPC has demonstrated benefit in homebound older adults, there is limited literature on the effects of HBPC on persons living with dementia (Nguyen HQ, Vallejo JD, Macias M, Shiffman MG, Rosen R, Mowry V, J Am Geriatr Soc 70:1136-46, 2021). Our goal is to develop a HBPC-focused dementia care intervention that integrates the components of two previously developed dementia care models and test the feasibility of implementing it in HBPC practices to improve the quality of life and wellbeing of homebound PLWD and their caregivers. METHODS We will first conduct qualitative focus groups at two HBPC practice sites, one in the Southeast and one in Hawaii in order to obtain preliminary feedback on the proposed intervention. At each site, there will be one focus group with caregivers of PLWD and another with HBPC clinicians and staff to help develop and refine our intervention. We will then conduct an open-pilot trial of the refined intervention at the two HBPC practices. A total of up to 25 patient/caregiver dyads will be recruited at each site (N = 50 total). Outcomes measured through pre-and-post assessments and exit interviews will include (a) feasibility for the caregiver to engage with and complete baseline assessments and access educational materials and community resources and (b) feasibility for the practice to identify potential caregivers/patients, assess eligible patient/caregiver dyads, use patient and caregiver assessments, recruit patient/caregiver dyads, recruit racial and ethnic minorities, use care modules, and engage with the tele-video case conference, (c) net promoter score, (d) acceptability of the intervention to caregivers and patients to participate in the intervention, (e) caregivers feeling heard and understood, and (f) caregiver well-being. DISCUSSION Testing the feasibility and acceptability of the adapted intervention in these two HBPC practices will provide the basis for future testing and evaluation of a fully powered intervention for PLWD and their caregivers cared for in HBPC with the goal of disseminating high-quality and comprehensive dementia-care focused interventions into HBPC practices. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov NCT05849259 in May 2023.
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Affiliation(s)
- Maimouna Sy
- Center for Aging and Serious Illness, Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Ayush Thacker
- Center for Aging and Serious Illness, Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Orla C Sheehan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine Seel Ritchie
- Center for Aging and Serious Illness, Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
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Dobbs D, Yauk J, Vogel CE, Fanfan D, Buck H, Haley WE, Meng H. Feasibility of the Palliative Care Education in Assisted Living Intervention for Dementia Care Providers: A Cluster Randomized Trial. Gerontologist 2024; 64:gnad018. [PMID: 36842068 DOI: 10.1093/geront/gnad018] [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: 11/06/2022] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Alzheimer's disease and related dementia (ADRD) is a major cause of death in the United States. While effective interventions have been developed to deliver palliative care to nursing home residents with ADRD, little work has identified effective interventions to reach assisted living (AL) residents with dementia. RESEARCH DESIGN AND METHODS One hundred and eighteen AL residents with dementia from 10 different ALs in Florida participated. A pilot study using a cluster randomized trial was conducted, with 6 sites randomized to receive a palliative care educational intervention for staff (N = 23) to deliver care to residents; 4 sites were usual care. The feasibility of the intervention was assessed by examining recruitment, retention, and treatment fidelity at 6 months. Cohen's d statistic was used to calculate facility-level treatment effect sizes on key outcomes (documentation of advance care planning [ACP] discussions, hospice admission, and documentation of pain screening). RESULTS The intervention proved feasible with high ratings of treatment fidelity. The intervention also demonstrated preliminary evidence for efficacy of the intervention, with effect sizes for the treatment group over 0.80 for increases in documentation of ACP discussions compared to the control group. Hospice admissions had a smaller effect size (0.16) and documentation of pain screenings had no effect. DISCUSSION AND IMPLICATIONS The pilot results suggest that the intervention shows promise as a resource for educating and empowering AL staff on implementing person-centered palliative care delivery to persons with dementia in AL. A larger, fully powered randomized trial is needed to test for its efficacy.
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Affiliation(s)
- Debra Dobbs
- School of Aging Studies, Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA
| | - Jessica Yauk
- School of Aging Studies, Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA
| | - Carlyn E Vogel
- School of Aging Studies, Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA
| | - Dany Fanfan
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Harleah Buck
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - William E Haley
- School of Aging Studies, Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA
| | - Hongdao Meng
- School of Aging Studies, Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA
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Brookman R, Parker S, Hoon L, Ono A, Fukayama A, Matsukawa H, Harris CB. Technology for dementia care: what would good technology look like and do, from carers' perspectives? BMC Geriatr 2023; 23:867. [PMID: 38104074 PMCID: PMC10725604 DOI: 10.1186/s12877-023-04530-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The development of technology in dementia care has largely been without consultation with carers, and has primarily focused on safety, monitoring devices, and supporting activities of daily living. Further, while involving end-users in the design of technology has been recommended, this is yet to become common practice. METHOD We conducted a mixed methods study with the aim of investigating carers' values and priorities for technology development, including prior experiences, barriers to use, and what they would like technology to do. Importantly, we asked carers for their design ideas and bespoke technology solutions for future development. RESULTS Carers of people living with dementia (N = 127), including both unpaid (n = 102) and paid carers (n = 25) residing in Australia, completed an online survey. In addition, a subsample of carers (n = 23) participated in semi-structured interviews. Findings demonstrate that carers want technology to be person-centred, customisable, and to increase opportunities for meaningful social connection. Findings also demonstrate the ability of carers to generate creative design solutions for dementia care. CONCLUSIONS These findings and implications will be discussed in relation to the importance of co-design with carers and engineers during the design phase of assistive technology. Also, the importance of technology to enhance, not replace, human-to-human social interactions is highlighted.
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Affiliation(s)
- Ruth Brookman
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, NSW, Australia.
| | | | | | - Asuka Ono
- Nippon Telegraph and Telephone (NTT), Tokyo, Japan
| | | | | | - Celia B Harris
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, NSW, Australia
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Schurian-Dąbrowska L, Krause K. Researching Words without Speaking Them. Language as Care Practice in Multi-Lingual Care Environments in Poland. Med Anthropol 2023; 42:815-827. [PMID: 37581532 DOI: 10.1080/01459740.2023.2223998] [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: 08/16/2023]
Abstract
Being able to speak and understand local languages is regarded as an important prerequisite for conducting fieldwork. In this article we reflect on fieldwork in which we did not speak the local language - Polish - but in which we could still learn something about a central practice in our field sites: how language was implicated in practices of care. Hanging out as linguistically constricted researchers propelled us to research situations in which care was done through using words as sounds and practices, rather than relying on meanings, and to relate to not sharing a language in new ways.
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Affiliation(s)
| | - Kristine Krause
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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Dufour I, Arsenault-Lapierre G, Guillette M, Dame N, Poitras ME, Lussier MT, Fortier A, Brunet J, Martin J, Laverdure M, Brousseau G, Bergman H, Couturier Y, Quesnel-Vallée A, Vedel I. Research protocol of the Laval-ROSA Transilab: a living lab on transitions for people living with dementia. BMC Health Serv Res 2023; 23:1255. [PMID: 37964248 PMCID: PMC10647081 DOI: 10.1186/s12913-023-10248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The Laval-ROSA Transilab is a living lab that aims to support the Laval Integrated Health and Social Services Centres (Quebec, Canada) in consolidating the Quebec Alzheimer Plan. It aims to improve care transitions between different settings (Family Medicine Groups, home care, and community services) and as such improve the care of people living with dementia and their care partners. Four transition-oriented innovations are targeted. Two are already underway and will be co-evaluated: A) training of primary care professionals on dementia and interprofessional collaboration; B) early referral process to community services. Two will be co-developed and co-evaluated: C) developing a structured communication strategy around the dementia diagnosis disclosure; D) designation of a care navigator from the time of dementia diagnosis. The objectives are to: 1) co-develop a dashboard for monitoring transitions; 2) co-develop and 3) co-evaluate the four targeted innovations on transitions. In addition, we will 4) co-evaluate the impact and implementation process of the entire Laval-ROSA Transilab transformation, 5) support its sustainability, and 6) transfer it to other health organizations. METHODS Multi-methods living lab approach based on the principles of a learning health system. Living labs are open innovation systems that integrate research co-creation and knowledge exchange in real-life settings. Learning health systems centers care improvement on developing the organization's capacity to learn from their practices. We will conduct two learning cycles (data to knowledge, knowledge to practice, and practice to data) and involve various partners. We will use multiple data sources, including health administrative databases, electronic health records data, surveys, semi-structured interviews, focus groups, and observations. DISCUSSION Through its structuring actions, the Laval-ROSA Transilab will benefit people living with dementia, their care partners, and healthcare professionals. Its strategies will support sustainability and will thus allow for improvements throughout the care continuum so that people can receive the right services, at the right time, in the right place, and from the right staff.
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Affiliation(s)
- Isabelle Dufour
- School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
| | | | - Maxime Guillette
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | - Nathalie Dame
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Thérèse Lussier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Annie Fortier
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Julie Brunet
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Julie Martin
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Ginette Brousseau
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Howard Bergman
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Yves Couturier
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Isabelle Vedel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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Akhter R, Sun W, Quevedo AJU, Lemonde M, Liscano R, Horsburgh S. Perceived barriers and solutions identified by healthcare professionals in utilizing web-based reminiscence therapy to support dementia care during the pandemic. Aging Clin Exp Res 2023; 35:2843-2846. [PMID: 37581860 DOI: 10.1007/s40520-023-02520-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/26/2023] [Indexed: 08/16/2023]
Abstract
This paper presents findings from a qualitative study conducted in Ontario, Canada, exploring healthcare professionals' perceptions of barriers and solutions for implementing Web-Based Reminiscence Therapy (WBRT) in an institutionalized settings for dementia care during the COVID-19 pandemic. The study identified five major barriers, including the lack of on-boarding/educational training, need for technology availability and technical support, limited attention span of persons with dementia (PWD), availability of multi-sensory features, and time constraints due to staff workload. Seven major themes emerged related to proposed solutions/suggestions: (1) involving younger generations, (2) focusing on technology training, (3) integrating with other digital platforms, (4) adding narratives/descriptions to recollect memories, (5) ensuring accessibility, (6) adding QR codes for retrieving information, and (7) combining digital/traditional reminiscence methods. These findings provide valuable insights for implementing WBRT to facilitate dementia care and for the future refinement of its application.
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Affiliation(s)
- Rabia Akhter
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada.
| | - Winnie Sun
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | | | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Ramiro Liscano
- Faculty of Engineering and Applied Science, Ontario Tech University, Oshawa, ON, Canada
| | - Sheri Horsburgh
- Geriatric Psychiatry Unit, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
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Heinrich S, Weissenfels I, Zeller A. Emotions, action strategies and expectations of health professionals and people with dementia regarding COVID-19 in different care settings in Switzerland: a mixed methods study. BMC Geriatr 2023; 23:631. [PMID: 37803286 PMCID: PMC10559654 DOI: 10.1186/s12877-023-04315-0] [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: 01/06/2023] [Accepted: 09/14/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND More than 55 million people are currently affected by dementia worldwide and over 144 thousand in Switzerland. In Swiss nursing homes, 47.6% of the residents had a medical diagnosis of dementia in 2014. Due to cognitive impairment, they have difficulties remembering hygiene measures or placing them in the epidemic context. This results in a higher infection risk. There are COVID-19-associated recommendations focused on dementia care management but studies simultaneously surveying and correlating perspectives of health professionals as well as people with dementia across care settings are largely lacking. This study is focused on COVID-19-associated perspectives and needs of health professionals and people with dementia across different care settings. Lessons learned from the pandemic shall be pointed out. METHODS We conducted a mixed-methods approach based on an exploratory sequential design. Two qualitative interview rounds (n = 15 participants) and a quantitative online survey (n = 148 participants) with people with dementia, caring relatives, Advanced Practice Nurses and nursing home managers (health professionals) were performed. Data collected was performed in nursing home and home-care settings. The SQRQ checklist was used. RESULTS Fear and uncertainty were highest at the beginning of the pandemic among the interviewed nursing professionals and nursing home managers. As a positive side effect of the pandemic, increased cohesion in care teams was reported. Some people with dementia experienced the decelerated outside world as pleasant and less challenging to master. Particularly during the first wave, nursing home managers rated political decision-making processes as being too slow, partly non-transparent, inconsistent, and sometimes inappropriate for people with dementia. CONCLUSIONS Although the identified emotional and physical consequences of the COVID-19 pandemic are mostly negative for health professionals and people with dementia, research should also investigate potential positive side effects. Furthermore, political decisions should be passed on to care institutions as promptly, transparently, and comprehensibly as possible. The results provide guidance on dementia-focused COVID-19 management interventions incorporating lessons learned and considering the emotional impact of the pandemic in Switzerland and beyond.
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Affiliation(s)
- Steffen Heinrich
- Dementia Competence Centre, IPW Institute of Applied Nursing Science - Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, St.Gallen, 9001, Switzerland.
| | - Inga Weissenfels
- Dementia Competence Centre, IPW Institute of Applied Nursing Science - Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, St.Gallen, 9001, Switzerland
| | - Adelheid Zeller
- Dementia Competence Centre, IPW Institute of Applied Nursing Science - Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, St.Gallen, 9001, Switzerland
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Abstract
'Nostalgic environments' are increasingly being created in museums and institutional care settings for people with dementia, to support residents' capacities for memory and recognition. Drawing upon ethnography carried out in a public nursing home specialized in dementia care in Copenhagen, Denmark, this paper engages conceptually the employment of material heritage within dementia care environments, proposing dementia care as a 'curatorial' practice: caregivers act as 'curators' who re-establish and reorganize the 'meaning' of the residents by preserving their individual biographies and societal belonging. The analytical alignment of dementia care with the curating of cultural valuables reveals that the human is not only the subject within-and the creator of-cultural heritage, but also the object: the person with dementia is simultaneously an acting subject in care and an object for performances of the category of the human. As the curatorial care performed in nursing homes preserves not only individual, but also collective memories of what it takes to be human and belong in society, these institutions should be recognized as significant sites within society concerned with the production of meaning, value and cultural heritage.
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Affiliation(s)
- Iben M Gjødsbøl
- Department of Public Health, Centre for Medical Science and Technology Studies, University of Copenhagen, Øster Farimagsgade 5B, 1014, Copenhagen K, Denmark.
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Wangler J, Jansky M. What requirements do primary care physicians have with regard to dementia diagnostics and dementia care? - a survey study among general practitioners in Germany 2022/2023. Arch Public Health 2023; 81:155. [PMID: 37620850 PMCID: PMC10464123 DOI: 10.1186/s13690-023-01174-4] [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: 05/30/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND General practice offers good conditions to detect and provide care for dementia-related diseases. Nonetheless, the effectiveness of dementia care in general practice is repeatedly criticised. To date, few studies have attempted to form a comprehensive picture of the status quo of dementia care in general practice that focuses on GP perspectives of experience and action. The aim of this study was to identify potential strengths and weaknesses of GP-based dementia care, by means of combined consideration of relevant care and treatment dimensions (construct of 'dementia sensitivity'). METHODS Through an online poll, a total of 4,511 GPs who are active as treatment providers in Baden-Württemberg, Hesse, Rhineland-Palatinate and Saarland were surveyed between September 2022 and January 2023. In addition to the descriptive analysis, a T-test with independent samples was used to identify significant differences between two groups (interval-scaled or metric variables). Pearson's chi-squared test (χ2) was used to analyze the percentage values. Two levels of significance were tested for (mean difference at p < 0.05 and p < 0.001). In the course of the analysis, there were particular differences with regard to the sociodemographic variables 'urban vs. rural doctors' and 'doctors with geriatric training vs. doctors with no geriatric training'. Therefore, a complete listing of these parameters is given in the tables. In addition, the factor analysis method was employed. RESULTS The respondents consider it important for GPs to provide care and support for dementia patients. The doctors express the desire to offer active support to patients and their family caregivers. At the same time, many GPs experience challenges and difficulties when it comes to practical diagnostic steps (in line with guidelines), the (early) identification of dementia and consistent disease management, including the anticipation of care and treatment needs. Moreover, it appears that a significant proportion of the sample has only limited confidence when it comes to review relevant help and support services. One consistent finding is that some doctors in urban practices who also have geriatric training show substantial increases in knowledge and information with regard to dementia care. CONCLUSIONS In the light of the findings, it seems particularly advisable to strengthen the geriatric competence of GPs. Moreover, it seems to be essential to ensure that they are better informed about cooperation and support structures in the area of dementia care and better integrated into these.
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Affiliation(s)
- Julian Wangler
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg, University Mainz, Am Pulverturm 13, 55131, Mainz, Germany.
| | - Michael Jansky
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg, University Mainz, Am Pulverturm 13, 55131, Mainz, Germany
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Lauridsen S, Schou-Juul F, Folker AP, Simonsen P, Phil ME, Skov SS. Developing the CARE intervention to enhance ethical self-efficacy in dementia care through the use of literary texts. BMC Med Ethics 2023; 24:45. [PMID: 37386381 PMCID: PMC10311821 DOI: 10.1186/s12910-023-00926-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Dementia care is essential to promote the well-being of patients but remains a difficult task prone to ethical issues. These issues include questions like whether manipulating a person with dementia is ethically permissible if it promotes her best interest or how to engage with a person who is unwilling to recognize that she has dementia. To help people living with dementia and their carers manage ethical issues in dementia care, we developed the CARE intervention. This is an intervention focused on promoting the ethical self-efficacy of people living with dementia and carers, i.e., their confidence that they can manage ethical issues when they occur. The purpose of this paper is to explain and discuss how we have developed the CARE intervention to promote the ethical self-efficacy of people living with dementia, their family, and professional carers through a specific and, we believe, new use of literary texts. METHODS The CARE intervention has been developed in two phases: First, we conducted a needs assessment of the occurrence of ethical issues in dementia care and the need for an intervention to support people living with dementia and their carers in managing such issues. Second, in a design phase, we developed the CARE intervention to meet identified needs. RESULTS To address identified ethical issues in dementia care we designed the CARE intervention as a workshop format where people living with dementia and carers can meet, discuss literary texts, and deliberate on how to solve such issues. The workshop is structured by the following elements: An agenda of ethical issues, a collection of literary cases exemplifying ethical issues, a moderator with an understanding of dementia care, and an overview of the ethical principles relevant to the discussion of ethical issues. >This workshop concept is operationalized in three applications tailored to meet the specific ethical issues of each of the study´s three target groups: people living with dementia and family carers, professional and family carers, and professional carers. CONCLUSION We conclude the paper by stating that it is possible to develop an intervention that promotes the ethical self-efficacy of people living with dementia and family and professional carers.
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Affiliation(s)
- Sigurd Lauridsen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| | - Frederik Schou-Juul
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Anna Paldam Folker
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Peter Simonsen
- Department Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
| | - Marie-Elisabeth Phil
- Department Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
| | - Sofie Smedegaard Skov
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Duarte N, Alves S, Gomes B. Evaluation of a Dementia Training Course for Staff of a Center of Dementia Care. Dement Geriatr Cogn Disord 2023; 52:205-213. [PMID: 37257431 PMCID: PMC10614232 DOI: 10.1159/000529856] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/13/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Literature shows poor dementia training and competencies among health and social professionals. Due to the growing prevalence of people with dementia and all the related care demands, specialized training is increasingly needed but must be effective in terms of impact on knowledge, behaviors, and attitudes. We aimed to analyze the impact of a first-level dementia training course for staff of a new specialized center for people with dementia, considering the first three levels of Kirkpatrick's evaluation framework, namely, staff reaction (satisfaction), skills and learning (knowledge and dementia attitudes), and behavior changes. METHODS This is a single-center group pre-post design study of a 12-session online course. An online questionnaire was administered to measure satisfaction, expectations, knowledge/learning, attitudes (Dementia Attitude Scale), and new behaviors/practices. We compared perceived knowledge (Wilcoxon signed-rank test) and attitudes (paired t test). Thematic analysis explored new behaviors/practices. RESULTS Eighty-five professionals and 1 volunteer were included (median age 31, 92% female). Satisfaction with the training was high (median 4/5). Perceived knowledge improved (median 3-4; p < 0.001). The knowledge test median score was 70.8%. After training, participants showed better attitudes toward dementia (mean 116.5, SD 10.3, to mean 122.2, SD 11.5; p < 0.001). Most (93%) said their behavior/practice changed. Thematic analysis yielded four new behavior/practice dimensions: care provision/interaction, communication, family/caregivers, and self-confidence. CONCLUSIONS The course improved all dimensions evaluated, suggesting it effectively provides first-level dementia training. This may be transferable to similar settings.
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Affiliation(s)
- Natália Duarte
- Santa Casa da Misericórdia de Riba D’Ave, CIDIFAD – Centro de Investigação, Diagnóstico, Formação e Acompanhamento das Demências, Riba de Ave, Portugal
- CINTESIS@RISE, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Sara Alves
- Santa Casa da Misericórdia de Riba D’Ave, CIDIFAD – Centro de Investigação, Diagnóstico, Formação e Acompanhamento das Demências, Riba de Ave, Portugal
- CINTESIS@RISE, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Barbara Gomes
- Santa Casa da Misericórdia de Riba D’Ave, CIDIFAD – Centro de Investigação, Diagnóstico, Formação e Acompanhamento das Demências, Riba de Ave, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
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Mohr W, Rädke A, Afi A, Weber N, Platen M, Mühlichen F, Scharf A, Michalowsky B, Hoffmann W. Do They Align? Congruence Between Patient Preferences of People Living with Cognitive Impairments and Physicians' Judgements for Person-Centered Care: An Analytic Hierarchy Process Study. J Alzheimers Dis 2023; 91:727-741. [PMID: 36502324 PMCID: PMC9912726 DOI: 10.3233/jad-220753] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Person-centered care (PCC) requires knowledge about patient preferences. Among people living with cognitive impairments (PlwCI), evidence on quantitative, choice-based preferences, which allow to quantify, weigh, and rank care elements, is limited. Furthermore, data on the congruence of patient preferences with physicians' judgements for PCC are missing. Such information is expected to support the implementation of PCC; state-of-the-art medical care aligned with patients' preferences. OBJECTIVE To elicit patient preferences and physicians' judgements for PCC and their congruence. METHODS Data from the mixed-methods PreDemCare study, including a cross-sectional, paper-and-pencil, interviewer-assisted analytic hierarchy process (AHP) survey conducted with n = 50 community-dwelling PlwCI and n = 25 physicians. Individual AHP weights (preferences/judgements) were calculated with the principal eigenvector method and aggregated per group by aggregation of individual priorities mode. Individual consistency ratios (CRs) were calculated and aggregated per group. Group differences in preferences/judgements were investigated descriptively by means and standard deviations (SDs) of AHP weights, resulting ranks, and boxplots. Additionally, differences between groups were investigated with independent paired t-test/Mann Whitney U-test. Sensitivity of AHP results was tested by inclusion/exclusion of inconsistent respondents, with an accepted threshold at CR≤0.3 for patients, and CR≤0.2 for physicians, due to better cognitive fitness of the latter group. RESULTS Patient preferences and physicians' judgements did not differ significantly, except for the criterion Memory Exercises (AHP weights (mean (SD)): 0.135 (0.066) versus 0.099 (0.068), p = 0.01). We did not see rank-reversals of criteria after exclusion of inconsistent participants. Mean CR for patients at the criteria level was 0.261, and 0.181 for physicians. CONCLUSION Physicians' judgements in our setting aligned well with patients' preferences. Our findings may be used to guide the implementation of preference-based PCC.
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Affiliation(s)
- Wiebke Mohr
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Germany,Correspondence to: Wiebke Mohr, German Center for Neurodegenerative Diseases e.V., Ellernholzstraße 1-2, 17487 Greifswald, Germany. Tel.: +49 3834 86 8537; E-mail:
| | - Anika Rädke
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Germany
| | - Adel Afi
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Germany
| | - Niklas Weber
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Germany
| | - Moritz Platen
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Germany
| | - Franka Mühlichen
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Germany
| | - Annelie Scharf
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Germany,
Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Germany
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Kellett K, Robison J, McAbee-Sevick H, Gitlin LN, Verrier Piersol C, Fortinsky RH. Implementing the Care of Persons With Dementia in Their Environments (COPE) Intervention in Community-Based Programs: Acceptability and Perceived Benefit From Care Managers' and Interventionists' Perspectives. Gerontologist 2023; 63:28-39. [PMID: 35581164 PMCID: PMC9872768 DOI: 10.1093/geront/gnac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Nonpharmacologic interventions have demonstrated benefits for people living with dementia and their caregivers. Few studies have evaluated their implementation in real-world settings. Using normalization process theory (NPT), an implementation science framework, this study evaluated the acceptability of the care of persons with dementia in their environments (COPE) intervention by care managers and interventionists implemented in a Medicaid and state-revenue funded home and community-based services (HCBS) program. RESEARCH DESIGN AND METHODS NPT and data from 9 care manager focus groups (n = 61) and 2 interventionist focus groups (n = 8) were utilized to understand COPE acceptability to program care managers and interventionists. NPT's 4 criteria, coherence, cognitive participation, collective action, and reflexive monitoring, framed the research questions used to evaluate the intervention's implementation. RESULTS Care managers and interventionists demonstrated a shared understanding of COPE aims and the value of practices implemented (coherence). Training by national experts facilitated program buy-in to meet COPE goals and was demonstrated by care managers and interventionists as they used the training to broaden their program involvement (cognitive participation). Operational work done by care managers and interventionists to implement the intervention (collective action) and their shared perceptions of program benefits (reflexive monitoring) contributed to program implementation, families' positive responses to COPE and enhanced sustainability. DISCUSSION AND IMPLICATIONS Introducing evidence-based dementia care interventions into HCBS programs strongly depends upon building shared understandings between care managers and interventionists and valuing the contributions of all stakeholders involved in delivering care innovations to people living with dementia and their caregivers.
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Affiliation(s)
- Kathy Kellett
- UConn Center on Aging, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
| | - Julie Robison
- UConn Center on Aging, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
| | - Heather McAbee-Sevick
- UConn Center on Aging, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Richard H Fortinsky
- UConn Center on Aging, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
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Tsukii N, Nakamura K, Yamaguchi H. [Effectiveness in reducing BPSD of care intervention using the Himotoki Sheet from the perspective of individuals with dementia]. Nihon Ronen Igakkai Zasshi 2023; 60:424-433. [PMID: 38171760 DOI: 10.3143/geriatrics.60.424] [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: 01/05/2024]
Abstract
AIM This study aimed to examine the effect of intervention using the Himotoki Sheet versus conventional care on behavioral and psychological symptoms of dementia (BPSD) in residents of care facilities. METHODS This non-randomized controlled trial included 37 institutionalized individuals with dementia. During the four-week intervention period, the care workers in the intervention group, which consisted of 17 participants, were asked to 1) select one BPSD item for intervention from the items of the Behavioral and Psychological Symptoms of Dementia Plus Questionnaire (BPSD+Q), 2) complete the Himotoki Sheet and share information about the BPSD focused on by the team led by the Himotoki Sheet manager, and 3) provide care according to the contents of the Himotoki Sheet. The 18 patients in the control group received conventional care for four weeks. A two-way analysis of variance was used to compare changes in scores between groups and the BPSD+Q. RESULTS A total of 32 participants (intervention group, n=16; control group, n=16) were analyzed. There were no significant differences in basic attributes between the groups. There was a significant interaction between the group and the BPSD+Q distress score (F=4.704, p=0.038) and Hyperactive domain distress score (F=4.946, p=0.034). The BPSD+Q (p=0.002) and Hyperactive domain (p=0.001) distress scores were significantly reduced in the intervention group but not the control group. CONCLUSIONS In comparison to conventional care, care using the Himotoki Sheet was associated with a significant reduction in the BPSD+Q and Hyperactive domain distress scores.
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Affiliation(s)
- Naoya Tsukii
- Tokyo Center for Dementia Care Research and Practices
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20
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Xu YA, Wang Y, Kim SSY, Kim DOD, Sun Y, McLaughlin ML. Safe at home: Acceptance of surveillance technology among caregivers for persons with dementia. Health Informatics J 2023; 29:14604582231152188. [PMID: 36680337 DOI: 10.1177/14604582231152188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The increasing incidence of dementia calls for effective and innovative approaches to alleviate societal and personal burdens. Aging in place is a sustainable paradigm which ensures the best utilization of societal resources, supports caregivers, secures normalcy, and optimizes care for persons with dementia (PwD). Home-based surveillance technology can support PwD in safely aging in place. This study examines factors associated with the adoption of home-based surveillance technologies among unpaid dementia caregivers. Through an online survey (N = 203), we apply ordinal logistic regression to identify five variables that predict the likelihood of caregivers' surveillance technology adoption for dementia care. The predictors are caregivers': (1) trouble concerns about PwD, (2) online support group membership, (3) perceived social norms regarding surveillance technology use, (4) perceived usefulness of surveillance devices, and (5) depth of information and communication technologies (ICT) use. Theoretical and practical implications for dementia healthcare are discussed.
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Affiliation(s)
- Yusi Aveva Xu
- Annenberg School for Communication and Journalism, 5116University of Southern California, Los Angeles, CA, USA
| | - Yunwen Wang
- Annenberg School for Communication and Journalism, 5116University of Southern California, Los Angeles, CA, USA
| | - Steffie Sofia Yeonjoo Kim
- Annenberg School for Communication and Journalism, 5116University of Southern California, Los Angeles, CA, USA
| | - Do Own Donna Kim
- Annenberg School for Communication and Journalism, 5116University of Southern California, Los Angeles, CA, USA
| | - Yao Sun
- Annenberg School for Communication and Journalism, 5116University of Southern California, Los Angeles, CA, USA
| | - Margaret L McLaughlin
- Annenberg School for Communication and Journalism, 5116University of Southern California, Los Angeles, CA, USA
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Abstract
We explore the creation of private care facilities around Chiang Mai in northern Thailand to provide dementia care for people from the Global North. We draw on three periods of ethnographic observation at care facilities, and interviews with Swiss and British owners and family members, as well as Thai managers and care workers. We locate this offshoring of dementia care from the Global North to South within existing underfunding of dementia care in the Global North and a "regime of anticipation" built around expected substantial growth in the numbers of people living with dementia. These facilities are opening new futures for those who migrate for care as they leverage their relative wealth and privilege to purchase care in Thailand. In line with other readings of international health migration, we note the negative impact of this state-supported privatized industry on the availability of nurses and care aids in public hospitals in Thailand. We then venture into less examined and expected futurities, namely, the opportunities these facilities provide to two groups of stigmatized Thai workers: transgender and Indigenous Karen caregivers.
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Affiliation(s)
- Geraldine Pratt
- Department of Geography, University of British Columbia, Vancouver, BC, Canada
| | - Caleb Johnston
- School of Geography, Politics and Sociology, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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22
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Hoffman AL, Bergmann JM, Fahsold A, Müller-Widmer R, Roes M, Holle B, Palm R. Measuring person-centred care in german nursing homes - exploring the construct validity of the Dementia Policy Questionnaire: a cross-sectional study of a secondary data set. BMC Geriatr 2022; 22:914. [PMID: 36443654 PMCID: PMC9706957 DOI: 10.1186/s12877-022-03586-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/04/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To ensure the sustainable implementation of dementia-specific person-centred care (PCC) in nursing homes, internal policies are crucial. The preliminary German Dementia Policy Questionnaire, which features 19 dichotomous items, assesses the existence of and evaluates these policies. This article reports the results of an exploration of the construct validity of the preliminary Dementia Policy Questionnaire. METHODS This study is a cross-sectional study that references a secondary data set drawn from a national survey study of a randomized, stratified sample of 134 nursing homes in Germany. To explore the construct validity of the preliminary Dementia Policy Questionnaire, we conducted an adjusted multiple correspondence analysis of the pretested 19-item assessment. We included data assessed using the preliminary Dementia Policy Questionnaire from 134 care units associated with 134 nursing homes; these data were collected via telephone interviews with nursing home administrators or their representatives. RESULTS Two items assessing visitor regulations and regulations regarding the inclusion of residents in staff selection were less frequent and were therefore excluded from the adjusted multiple correspondence analysis. In total, nine items were assigned to two dimensions. The items assigned to the first dimension assess existing regulations for PCC as well as existing regulations regarding the involvement of the resident, relatives and the multiprofessional team in the collection of information concerning preferences, case conferences or decision making. The items assigned to the second dimension assess existing regulations regarding the systematic assessment of resident preferences and their requirements. CONCLUSION The study produces exploratory evidence concerning the preliminary Dementia Policy Questionnaire. Since the dimensions of the items included in this questionnaire cannot be conceptualized clearly, the instrument in its current state requires further development.
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Affiliation(s)
- Anna Louisa Hoffman
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Stockumer Str. 12, 58453 Witten, Germany ,grid.412581.b0000 0000 9024 6397Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Alfred- Herrhausen-Straße 50, 58448 Witten, Germany
| | - Johannes Michael Bergmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Stockumer Str. 12, 58453 Witten, Germany ,grid.412581.b0000 0000 9024 6397Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Alfred- Herrhausen-Straße 50, 58448 Witten, Germany
| | - Anne Fahsold
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Stockumer Str. 12, 58453 Witten, Germany ,grid.412581.b0000 0000 9024 6397Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Alfred- Herrhausen-Straße 50, 58448 Witten, Germany
| | - René Müller-Widmer
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Stockumer Str. 12, 58453 Witten, Germany ,grid.412581.b0000 0000 9024 6397Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Alfred- Herrhausen-Straße 50, 58448 Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Stockumer Str. 12, 58453 Witten, Germany ,grid.412581.b0000 0000 9024 6397Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Alfred- Herrhausen-Straße 50, 58448 Witten, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Stockumer Str. 12, 58453 Witten, Germany ,grid.412581.b0000 0000 9024 6397Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Alfred- Herrhausen-Straße 50, 58448 Witten, Germany
| | - Rebecca Palm
- grid.412581.b0000 0000 9024 6397Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Alfred- Herrhausen-Straße 50, 58448 Witten, Germany
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Sun W, Bartfay E, Smye V, Biswas S, Newton D, Pepin M, Ashtarieh B. Living well with dementia: The role volunteer-based social recreational programs in promoting social connectedness of people with dementia and their caregivers. Aging Ment Health 2022; 26:1949-1962. [PMID: 34353187 DOI: 10.1080/13607863.2021.1950614] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/25/2023]
Abstract
Objectives: This evaluation study was designed to examine the factors that contribute the promotion of social connectedness among people with dementia and their caregivers through social recreational programs; develop an understanding of volunteer's impact on program success; and identify the barriers and facilitators to improve the volunteer-based programs to promote social connectedness.Method: A qualitative descriptive research design was used to explore the study participants' lived experiences of social recreational programs from Alzheimer's Society of Durham Region (ASDR) in Ontario, Canada. A final sample of 31 participants was recruited including people with dementia, informal caregivers, and community volunteers. Qualitative data was collected through face-to-face semi-structured interviews. Emerging themes were derived from the qualitative descriptive data using thematic analysis.Results: The qualitative interviews highlighted the impact of social recreational programs on people with dementia, caregivers and volunteers in the promotion of social connectedness, as well as the examination of barriers and facilitators to identify opportunities for the future improvement of ASDR programs that would benefit the dementia populations. The study findings revealed that the project 'Living Well with Dementia' has been able to successfully foster social connectedness through its volunteer-led social recreational programs by promoting the physical and mental well-being of people with dementia and their caregivers.Conclusion: Our study findings underscored the critical roles of volunteers who contributed to the success of community-based programs. Future research is needed to identify the opportunities to address current gaps in services and to strengthen the social recreational programs using evidence-based practices and client-centered approaches.Supplemental data for this article can be accessed online at http://doi.org/10.1080/13607863.2021.1950614.
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Affiliation(s)
- Winnie Sun
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Emma Bartfay
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Victoria Smye
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada
| | - Srija Biswas
- Master of Science in Community, Public and Population Health, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | | | | | - Bahar Ashtarieh
- Bachelor of Science in Nursing, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
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Ura C, Okamura T, Taga T, Yanagisawa C, Yamazaki S, Shimmei M. Living for the city: Feasibility study of a dementia-friendly care farm in an urban area. Int J Geriatr Psychiatry 2022; 37. [PMID: 35962553 DOI: 10.1002/gps.5794] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chiaki Ura
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Tsutomu Taga
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Takahashi T, Ekoyama S, Tachikawa H, Midorikawa H, Shiratori Y, Ota M, Takahashi S, Arai T. Mental Health of Caregivers Working in Nursing Homes during the COVID-19 Pandemic. Dement Geriatr Cogn Disord 2022; 51:233-240. [PMID: 35679835 PMCID: PMC9393777 DOI: 10.1159/000524953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/23/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION There have been numerous reports of cluster outbreaks of coronavirus disease 2019 (COVID-19) in hospitals and nursing homes. Healthcare workers fighting COVID-19 experience mental health issues. Caregivers in nursing homes experienced increased psychological distress and concern about deterioration of their mental health. We conducted a large-scale web-based survey exploring mental health among caregivers working in nursing homes during the COVID-19 pandemic with the aim of identifying their support needs. METHODS Survey participants were caregivers working at 284 nursing homes in Ibaraki prefecture, Japan. The survey period was from September 2020 to March 2021. Participants responded to a questionnaire covering gender, age, occupation, infections at facilities, infection protection, changes in nursing home users, cooperation with other medical institutions, and prejudice/discrimination. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate participants' depression and anxiety. RESULTS In total, 676 participants completed the survey; 350 (52.5%) were with anxiety symptoms and 378 (56.7%) were with depressive symptoms (scores exceeding the HADS cut-off points). The risk for anxiety was associated with being care worker or social worker. The risk of anxiety or depression was high when family caregivers' mental state changed. DISCUSSION/CONCLUSION This study found that caregivers working in nursing homes were exposed to high levels of stress during the COVID-19 pandemic and were at high risk for developing depression and anxiety.
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Affiliation(s)
- Takumi Takahashi
- Division of Psychiatry, University of Tsukuba Hospital, Tsukuba, Japan,
| | - Saori Ekoyama
- Division of Psychiatry, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hirokazu Tachikawa
- Division of Clinical Medicine, Department of Disaster and Community Psychiatry, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan,*Hirokazu Tachikawa,
| | | | - Yuki Shiratori
- Division of Clinical Medicine, Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Miho Ota
- Division of Clinical Medicine, Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sho Takahashi
- Division of Clinical Medicine, Department of Disaster and Community Psychiatry, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuaki Arai
- Division of Clinical Medicine, Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Shi C, Wong GHY, Choy JCP, Wong KKY, Lum TYS, Yu DSF. Are we on the same page? Multiple stakeholders and service users priorities for dementia care and policy: A Delphi study. Int J Nurs Stud 2022; 133:104300. [PMID: 35751948 DOI: 10.1016/j.ijnurstu.2022.104300] [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: 02/19/2022] [Revised: 05/03/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND It's crucial to develop a national policy for dementia due to the growing number of persons living with the condition and the attendant impact on individuals, families, and society at large. However, there has been limited exploration of the views on long-term goals for dementia of different stakeholders involved in different aspects of service use, planning or delivery. OBJECTIVE This study aims to examine and compare the perceived priorities of service users (i.e., people living with dementia and their family caregivers) and other multiple stakeholders for dementia care and policy. DESIGN Two independent Delphi studies were conducted in Hong Kong. SETTING(S) AND PARTICIPANTS In Delphi study 1, 75 stakeholders were recruited from public and private nursing, medical and social care providers, philanthropic organizations, policy-makers and government sectors. In Delphi study 2, 45 people living with dementia and 55 family caregivers were recruited from community care settings. METHODS The Delphi study 1 was conducted using online surveys, while the Delphi study 2 was conducted using phone interviews. Each Delphi study comprised a qualitative study for exploring the range of views of the two panels and a quantitative validation for generating consensus. We systematically compared the two panels' identified priorities in terms of contents and consensus levels. RESULTS Multiple stakeholders identified 32 consensus-based statements and service users identified 25 statements, most of which achieved moderate to high level of consensus. Through content analysis, statements from the two panels were converged into six common themes: (1) early prevention, detection and referral systems for dementia, (2) care and intervention services, (3) health and social care workforce capacity building within and across service sectors, (4) supportive services for family caregivers, (5) development of longer-term dementia service planning and a policy framework, and (6) promotion of a dementia-friendly community. Despite the similarity of the themes expressed by the two panels, critical comparison of their priorities identified the dementia service and policy gaps in providing integrated and informed healthcare, a mechanism for sensitive care allocation, enabling seamless social inclusion, and proactive health orientation of dementia caregivers. CONCLUSIONS Discrepancies between two panels reflect the distinctive value of service user engagement in the policy-making process. Our findings have implications for developing a multi-disciplinary integrated action plan for the local health response across the primary and secondary care settings to dementia and expanding the practice scope of person-centered dementia care in a collaborative way. TWEETABLE ABSTRACT The voices of user, caregivers and service stakeholders excel the person-centered care and policy context for integrated dementia care.
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Affiliation(s)
- Cheng Shi
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong; Center for Social Welfare Studies, Beijing Normal University, Beijing, China.
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Jacky C P Choy
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Kayla K Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Terry Y S Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
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Suzuki Y, Sudo T, Mochizuki H. Awareness of Instrumental Activities of Daily Living Disability: Pilot Study for Elderly Requiring Care and Caregivers. Dement Geriatr Cogn Dis Extra 2022; 12:94-99. [PMID: 35702344 PMCID: PMC9149450 DOI: 10.1159/000524155] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
Aim We aimed to investigate differences in the awareness of instrumental activities of daily living (IADL) disability between elderly patients with and without dementia requiring care. Methods We assessed 25 elderly individuals requiring care and their primary caregivers using the Lawton IADL scale, with score differences between the patients and their caregivers representing the level of impaired awareness of IADL disability. Results Among the participants, 80% exhibited impaired awareness of IADL disability. In terms of total score on the Lawton scale, there was no between-group difference in the occurrence of impaired awareness of IADL disability (p = 0.274, φ = 0.31). Contrastingly, regarding the subitems of the Lawton scale, the dementia group had a significantly higher number of participants with impaired awareness of responsibility for their own medications than the nondementia group (p = 0.030, φ = 0.47). Further, there were no significant between-group differences in the ability to use telephone, shopping, mode of transportation, or ability to handle finances. Conclusions It is important for caregivers to notice the emergence of impaired awareness among the elderly as soon as possible to ensure early diagnosis and treatment. The results of this study suggest the need for caregivers to take care of the elderly patients with the perspective that they may develop impaired awareness of responsibility for their own medications.
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Affiliation(s)
- Yukiko Suzuki
- Department of Occupational Therapy, Kyorin University, Tokyo, Japan
| | | | - Hideki Mochizuki
- Department of Occupational Therapy, Kyorin University, Tokyo, Japan
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Wangler J, Jansky M. [Team players or lone fighters? Importance and utilization of practice staff in primary care dementia detection]. Z Evid Fortbild Qual Gesundhwes 2022; 169:75-83. [PMID: 35190285 DOI: 10.1016/j.zefq.2021.12.009] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/11/2021] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND General practitioners (GP) face major challenges in everyday practice when it comes to identifying dementia cases as early as possible under the condition of time and resource constraints. The involvement of the practice staff promises decisive advantages in detection and diagnosis. So far, there has been a lack of studies exploring the extent to which non-medical practice employees in general practices are integrated into dementia detection, what experiences they have had and how they assess their own potential to contribute to more efficient dementia detection. METHODS Between August 2020 and August 2021, a total of 64 semi-structured, audio-technically recorded individual / expert interviews were conducted with non-medical practice employees (medical assistants) in general practices in all German federal states (four interviewees per federal state). The interview transcripts were evaluated using a qualitative, structuring content analysis according to Mayring (Software MAXQDA 2020). RESULTS The GP team members show a high degree of willingness and motivation to support the doctor in identifying and diagnosing dementia; situations have been reported where their assistance has led to an earlier identification of people with dementia. Observation and detection of dementia patients are rarely based on systematic criteria. On the whole, only some GPs entrust their staff with tasks like this. A large portion of the interviewees expressed considerable uncertainty regarding the assessment of possible signs of incipient dementia, which corresponds to the fact that only a minority of the interviewees have ever completed further training with a focus on dementia. CONCLUSIONS Practice staff can provide invaluable support when it comes to the timely and consistent detection of incipient dementia in general practice. In addition to sensitizing GPs and optimizing practice management, targeted training with regard to geriatric issues will be instrumental in achieving this. Accordingly, more advanced training formats should be developed that are tailored to the perspective of practice employees and convey important dementia-specific diagnostics, action and communication skills.
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Affiliation(s)
- Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Mainz, Deutschland.
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Mainz, Deutschland
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Abstract
BACKGROUND There is currently no cure for dementia but general practitioners (GPs) have therapeutic options available to counteract the progression of mild cognitive impairment, including drug and non-drug treatment. So far, few studies have investigated treatment strategies preferred by GPs. OBJECTIVES This study aimed to gain an overview of GPs' attitudes towards influencing the progression of dementia, their involvement regarding dementia prevention and perceived effective approaches. It also elucidated the challenges experienced by GPs and desired optimisation measures towards reinforcing secondary prevention. METHODS Between June 2020 and March 2021, 64 semi-standardised interviews amongst GPs were conducted in all federal states of Germany. Thirty interviews were carried out in person and 34 by phone. The data were analysed according to qualitative content analysis. RESULTS Many interviewees see great importance in secondary dementia prevention and believe they could make an effective contribution, some of them using non-drug approaches. GPs play a role in guiding patients and relatives towards support services. Some doctors consider drug treatment as the only option towards influencing the progression of dementia, showing low expectations on self-efficacy. Interdisciplinary collaboration is a frequent challenge, which often conflicts with a coherent treatment strategy. CONCLUSION Many GPs feel confident about influencing the progression of dementia and believe they can intervene effectively, using various (non-drug) treatment measures and referrals to support services. GPs perceive challenges, including obstacles in interdisciplinary collaboration and negative impacts after drug administration. To improve the conditions for GP intervention, it depends on expanding interdisciplinary collaboration and care strategies.
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Affiliation(s)
- Julian Wangler
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Mainz, Germany
| | - Michael Jansky
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Mainz, Germany
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30
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Wang J, Ding D, Wu B. Enhancement of Aging in Place: An Evolving Understanding of Person-Centered Dementia Care in Home Settings. J Alzheimers Dis 2022; 86:1315-1322. [PMID: 35213380 DOI: 10.3233/jad-215612] [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: 11/15/2022]
Abstract
BACKGROUND There has been a rich body of literature on informal caregivers of persons with dementia (PWD). However, little has been discussed on how to facilitate person-centered dementia care in home settings with spouses as primary caregivers. We tend to take it for granted that spouses provide person-centered care for PWD. However, being spouses of PWD and living with them for several decades does not necessarily mean that it is easier for them to provide person-centered dementia care and maintain valued and healthy relationships. OBJECTIVE The current study aimed to explore dyadic experiences of PWD and their spousal caregivers and develop a culturally and contextually-sensitive understanding of person-centered dementia care in home-based settings. METHODS A total of 20 dyads of PWD and their care partners were selected for this study. A trained qualitative interviewer conducted a one-on-one interview with each participant with dementia and their care partners separately. We adopted both conventional and directed content analyses. RESULTS Our findings provide examples of care partners provide person-centered care, resulting in a profound positive impact on their wellbeing. Adaptive leadership and collaborative work emerged as a key finding in facilitating person-centered dementia care. Cultural relevancy of person-centered dementia care was also interpreted from the data. The study findings provide implications for the evolving of person-centered dementia care model in home-based settings. CONCLUSION Findings from this study highlight the significance of facilitating person-centered dementia care in home-based settings between PWD and their primary family caregivers.
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Affiliation(s)
- Jing Wang
- Fudan University School of Nursing, Shanghai, China
| | - Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, NY, USA.,NYU Aging Incubator, New York, NY, USA
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Paplikar A, Rajagopalan J, Alladi S. Care for dementia patients and caregivers amid COVID-19 pandemic. Cereb Circ Cogn Behav 2022; 3:100040. [PMID: 35072119 PMCID: PMC8763414 DOI: 10.1016/j.cccb.2022.100040] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/13/2021] [Accepted: 01/16/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Multiple efforts have been taken across the world to bridge gaps in evidence and provide recommendations for dementia care and caregiver support during the COVID-19 pandemic. We aimed to review the available literature on measures used to alleviate the negative impacts of the pandemic on dementia care. METHODS We searched three databases: PubMed, CINAHL and PsycINFO to identify studies that described strategies that were recommended or taken to provide care and support to persons with dementia and their caregivers during the COVID-19 pandemic. RESULTS We included a total of 37 papers, originating from high, middle and low-income countries. We also included 6 papers exploring safety of COVID-19 vaccinations. Infection prevention recommendations predominantly involved providing consistent reminders to persons with dementia to engage in infection prevention measures and included measures to restrict wandering in long-term care settings to reduce spread of infection. Medical care included tele and video consultations to maintain and monitor clinical stability. Guidance for continuing rehabilitation activities for persons with dementia through remotely conducted cognitive stimulating activities, physical exercises and environmental modifications were further highlighted by multiple studies/articles. In addition, strategies to support caregivers were also advised and included teleconsultations and psycho-educational programs. CONCLUSION The COVID-19 pandemic has exposed gaps in health and social care systems across the world, but has also revealed the enduring dedication of clinicians, expert groups and dementia support organizations to modify and adapt existing dementia care services to meet the needs of persons with dementia and their caregivers during periods of emergency.
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Affiliation(s)
- Avanthi Paplikar
- Dr. S.R.Chandrasekhar Institute of Speech and Hearing, Bengaluru, India, 560084.,Department of Neurology, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, India, 560029
| | - Jayeeta Rajagopalan
- Department of Neurology, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, India, 560029
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, India, 560029
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Roberto KA, Savla J, McCann BR, Blieszner R, Knight AL. Dementia Family Caregiving in Rural Appalachia: A Sociocultural Model of Care Decisions and Service Use. J Gerontol B Psychol Sci Soc Sci 2021; 77:1094-1104. [PMID: 34951643 PMCID: PMC9159069 DOI: 10.1093/geronb/gbab236] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Examinations of cultural variations in caregiving experiences and practices tend to focus on racially and ethnically diverse family caregivers. We extended this research by exploring the role of place-based cultural constructs on care decisions of family caregivers for persons living with dementia in rural Appalachia whose experiences and backgrounds dwell outside the lines of dominant culture. METHODS Guided by our sociocultural conceptual model of service use and a descriptive qualitative study design, we conducted in-depth interviews with 30 caregivers for persons living with dementia to understand how predisposing and enabling factors influence caregiving decisions, including the use of services to care for persons living with dementia. RESULTS Three predisposing factors reflecting the culture of rural Appalachian counties in Virginia (reasons for becoming a caregiver, previous caregiving experience, and deference to the person living with dementia) shaped decisions about caregiving responsibilities and service use. Three place-based enabling factors (a personal sense of belonging, knowledge of services, and family support for service use) played an important role in facilitating access to services. DISCUSSION Findings revealed subtle variation across caregivers in this study and in comparison, to caregivers' experiences more generally. We interpret these variations in light of culturally influenced attitudes, family norms, and sources of information about formal services. Place-based cultural experience influenced dementia family caregivers' behaviors and choices regarding formal service use, suggesting that investigators should pay more attention to cultural influences in future caregiving research.
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Affiliation(s)
- Karen A Roberto
- Address correspondence to: Karen A. Roberto, PhD, Center for Gerontology, Virginia Tech, 230 Grove Lane (0555), Blacksburg, VA 24061, USA. E-mail:
| | - Jyoti Savla
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | | | | | - Aubrey L Knight
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA,Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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Franzen S, Eikelboom WS, van den Berg E, Jiskoot LC, van Hemmen J, Papma JM. Caregiver Burden in a Culturally Diverse Memory Clinic Population: The Caregiver Strain Index-Expanded. Dement Geriatr Cogn Disord 2021; 50:333-340. [PMID: 34700324 DOI: 10.1159/000519617] [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: 08/03/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Although qualitative studies have highlighted substantial barriers to dementia diagnosis and care in culturally diverse populations in Europe, quantitative studies examining the level of caregiver burden in these populations have been lacking thus far and are urgently needed. METHODS We compared the caregiver burden levels on the Caregiver Strain Index (CSI)-Expanded of 63 culturally diverse patient-caregiver dyads from a multicultural memory clinic with 30 native Dutch patient-caregiver dyads and examined the association between caregiver burden and determinants of burden. RESULTS Informal caregivers in the multicultural memory clinic cohort experienced a high level of caregiver burden (mean CSI-score multicultural cohort: 6.1 [SD: 3.3]; mean CSI-score native Dutch cohort: 4.8 [SD: 3.2]). Burden was significantly associated with impairment on proxy-rated and objective measures of cognitive functioning, such as the Informant Questionnaire on Cognitive Decline and the Rowland Universal Dementia Assessment Scale, and with instrumental activities of daily living. Burden was the highest in spousal caregivers. The positive subscale of the CSI-Expanded provided limited additional information. CONCLUSION Caregivers of culturally diverse patients experience a high level of caregiver burden, in particular at more advanced disease stages. This study highlights the need to screen culturally diverse caregivers in European memory clinics on caregiver burden to identify those in need of caregiver support.
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Affiliation(s)
- Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Willem S Eikelboom
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lize C Jiskoot
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Judy van Hemmen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Jäger SC, Filbert AL, Welchowski T, Weltermann B. Effects of the dementia care toolbox on personnel's self-reported confidence in patient care: a CRT in general practices. BMC Fam Pract 2021; 22:231. [PMID: 34789149 PMCID: PMC8597294 DOI: 10.1186/s12875-021-01577-8] [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] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022]
Abstract
Background In rapidly aging populations, general practitioners (GPs) are challenged in dementia care of patients with and without migration background. Uncertainties in treating dementia in migrant patients due to language barriers or information deficits are reported. To address these deficits, we developed the Dementia Care Toolbox which was judged helpful by GP practice personnel. This two-armed cluster-randomised trial (CRT) investigated the effects of this toolbox on German GPs’ and practice assistants’ (PrAs) attitudes and confidence in dementia care, especially in patients with migration background. Methods A total of 32 GP practices were recruited and randomised into intervention (toolbox use for 3 months) and waiting-list control (toolbox after follow-up). After 3 months all participating GPs and PrAs received a standardised questionnaire addressing their levels of self-reported confidence in dementia care for patients with and without migration background. A generalized estimating equation model that took practice cluster effects into account was applied to assess GPs and PrAs self-reported confidence in dementia care in patients with and without migration background. Results Overall, the intervention had no significant effect on self-reported confidence in dementia care. However, the use of the dementia care toolbox showed a tendency for a learning effect on knowledge about local support structures for migrant patients with dementia (odds ratio 1.43; 95% CI 0.68-3.03, p = 0.35) and for less communication difficulties with dementia patients in general (odds ratio 0.72; 95% CI 0.33-1.56; p = 0.40). Moreover, intervention practices showed a tendency towards more awareness of own limitations: less self-confidence regarding answering questions (odds ratio 0.82; 95% CI 0.36-1.86, p = 0.64) and providing information for patients with migration background (odds ratio 0.60; 95% CI 0.25-1.45, p = 0.26). Conclusion The Toolbox Dementia Care increased awareness on the respective topic. Given a small sample size, further studies on its effectiveness in primary care are needed. Trial registration German Clinical Trials Register, DRKS00014632. Registered 02/08/2018.
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Affiliation(s)
- Sabine Christine Jäger
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Anna-Liesa Filbert
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Thomas Welchowski
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Fang B, Liu H, Yan E. Association Between Caregiver Depression and Elder Mistreatment-Examining the Moderating Effect of Care Recipient Neuropsychiatric Symptoms and Caregiver-Perceived Burden. J Gerontol B Psychol Sci Soc Sci 2021; 76:2098-2111. [PMID: 33598710 DOI: 10.1093/geronb/gbab025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine the association between caregiver (CG) depression and increase in elder mistreatment and to investigate whether change in care recipient (CR) neuropsychiatric symptoms (NPS) and change in CG-perceived burden influence this association. METHODS Using 2-year longitudinal data, we analyzed a consecutive sample of 800 Chinese primary family CGs and their CRs with mild cognitive impairment or mild-to-moderate dementia recruited from the geriatric and neurological departments of 3 Grade-A hospitals in the People's Republic of China. Participatory dyads were assessed between September 2015 and February 2016 and followed for 2 years. RESULTS CG depression at baseline was associated with a sharper increase in psychological abuse and neglect. For CRs with increased NPS, having a depressed CG predicted a higher level of psychological abuse than for those CRs without NPS. For CGs with decreased burden, the level of depression was associated with a slower increase in neglect than for CGs who remained low burden. DISCUSSION This study showed the differential impact of CG depression on the increase in elder mistreatment depending on the change in CR NPS and CG-perceived burden. The present findings provide valuable insights into the design of a systematic and integrative intervention protocol for elder mistreatment that simultaneously focuses on treating CG depression and perceived burden and CR NPS.
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Affiliation(s)
- Boye Fang
- School of Sociology & Anthropology, Sun Yat-sen University, Guangdong Province, China
| | - Huiying Liu
- Department of Sociology, Central South University, Changsha, Hunan Province, China
| | - Elsie Yan
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
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Fuju T, Yamagami T, Ito M, Naito N, Yamaguchi H. Development and Evaluation of the Behavioral and Psychological Symptoms of Dementia Questionnaire 13-Item Version (BPSD13Q). Dement Geriatr Cogn Dis Extra 2021; 11:222-226. [PMID: 34721499 PMCID: PMC8543349 DOI: 10.1159/000518973] [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: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Most behavioral and psychological symptoms of dementia (BPSD) scales have copyright issues and are difficult for care staff to use in daily care settings because they were primarily designed for physicians. Therefore, an easier tool for care staff is required. This study aimed to develop and validate the BPSD questionnaire 13-item version (BPSD13Q). Methods We obtained data from 444 people with dementia living in group homes in Japan using the BPSD plus questionnaire (BPSD + Q; 27-item version) and Neuropsychiatric Inventory Nursing Home version (NPI-NH). We selected appropriate items to make a short-form version of the BPSD + Q and examined the construct validity, internal consistency, and criterion-related validity of the questionnaire. Results By the pilot review, research on correlations with similar items from comparable scales, and factor analysis, we reduced 27 items to 13 items (BPSD13Q). The BPSD13Q and BPSD13Q-distress (BPSD13Q-D) showed good internal consistency (Cronbach's α = 0.76 and 0.80, respectively). Moreover, the BPSD13Q was positively correlated with the NPI-NH (r = 0.72, p < 0.001) and BPSD + Q (r = 0.95, p < 0.001). The BPSD13Q-D was positively correlated with the NPI-NH-caregiver distress (r = 0.74, p < 0.001) and BPSD + Q-distress (r = 0.96, p < 0.001). Conclusion We developed and validated the BPSD13Q, which is a short-form version of the BPSD + Q and is downloadable. The BPSD13Q may make BPSD evaluations easier for the care staff.
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Affiliation(s)
- Taiga Fuju
- Tokyo Center for Dementia Care Research and Practices, Suginami, Japan.,Medical Corporation TAISEIKAI/UCHIDA Hospital, Numata, Japan
| | - Tetsuya Yamagami
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Mio Ito
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
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Lindgren E, Sörenson J, Wattmo C, Kåreholt I, Nägga K. Differences in Dementia Care Between Swedish-Born and Foreign-Born from Countries with Different Country Level Socioeconomic Position: A Nationwide Register-Based Study. J Alzheimers Dis 2021; 84:1363-1371. [PMID: 34657886 PMCID: PMC8673530 DOI: 10.3233/jad-210734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 11/17/2022]
Abstract
Background: With a growing elderly population worldwide, the prevalence of dementia is rapidly increasing. Studies from high income countries have shown that belonging to a minority ethnic group increases the risk of health disadvantages. Objective: The aim of the present registry-based study was to identify potential differences in diagnostics, treatment, and care of individuals with dementia focusing on foreign-born in Sweden and the impact of country level socioeconomic position (SEP). Methods: The study was based on a large dataset from the Swedish Dementia Registry (SveDem) and the Swedish Tax Agency’s population registry. Data on demographic variables, cognitive tests, clinical assessments, medication, diagnosis, and interventions initiated at diagnosis were collected. Country level SEP was determined by country of birth as classified by World Bank Country and Lending groups. Results: Of 57,982 patients with dementia registered in SveDem, 7,171 (12.4%) were foreign-born. The foreign-born were significantly younger at diagnosis (p < 0.001), had a lower MMSE score (p < 0.001), lower odds of receiving a specific dementia diagnosis (p < 0.001), lower use of acetylcholinesterase inhibitors (p < 0.001), and overall a higher use of neuroleptics compared with the Swedish-born group. The lower SEP, the greater differences to Swedish-born were seen in many of the examined variables. Conclusion: There were significant differences in dementia diagnostics, treatment, and care between foreign-born and Swedish-born, a lower SEP indicating greater differences. Further research should focus on various socioeconomic aspects and health care outcomes for a more profound analysis of equity in dementia care.
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Affiliation(s)
- Emma Lindgren
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | | | - Carina Wattmo
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Ingemar Kåreholt
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Institute of Gerontology, School of Health and Welfare, Aging Research Network - Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
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Kim B, Lee Y, Noh JW, Kim TH. Factors Associated with Health Check-up and Cancer Screening Participation among Family Caregivers of Patients with Dementia: A Cross-Sectional Study. BMC Public Health 2021; 21:1753. [PMID: 34565358 PMCID: PMC8474929 DOI: 10.1186/s12889-021-11768-8] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/10/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Providing care for patients with dementia can negatively influence the physical health and health behaviours of family caregivers. A better understanding of the factors associated with health check-up and cancer screening participation is vital for developing effective interventions. Thus, this study aimed to identify factors associated with health check-up and cancer screening participation among family caregivers of patients with dementia. METHODS This was a cross-sectional study that analysed the data of 2,414 family caregivers of patients with dementia collected by the Korea Community Health Survey in 2017. A binomial logistic regression analysis was performed to identify demographic, socioeconomic, and health status factors associated with health check-up and cancer screening participation among family caregivers of patients with dementia. RESULTS Health check-up and cancer screening rates among family caregivers of patients with dementia were 68.7% and 61.4%, respectively, which were significantly lower than the rates for individuals who were not caregivers of patients with dementia. Those with lower education levels had lower odds ratios (OR) for both health check-up (OR: 0.60) and cancer screening (OR: 0.59) participation. In addition, symptoms of depression were associated with lower participation (health check-up OR: 0.67; cancer screening OR: 0.65). CONCLUSIONS More targeted disease prevention and management strategies must be developed for family caregivers of patients with dementia, particularly those with depressive symptoms and lower education levels.
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Affiliation(s)
- Bomgyeol Kim
- Department of Public Health, Graduate School, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yejin Lee
- Department of Public Health, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jin-Won Noh
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, 1 Yeonsedae-gil, Wonju-si, Gangwon-do, Republic of Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Juengst S, Supnet C, Kew CLN, Silva V, Vega M, Han G, Kelley B, Smith ML, Maestre G. Bilingual problem-solving training for caregivers of adults with dementia: A randomized, factorial-design protocol for the CaDeS trial. Contemp Clin Trials 2021; 108:106506. [PMID: 34273551 PMCID: PMC8453060 DOI: 10.1016/j.cct.2021.106506] [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: 04/07/2021] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Caregivers of individuals with Alzheimer's disease and related dementias (ADRD) often experience debilitating caregiver burden and emotional distress. To address these negative emotional consequences of caregiving, we will test and refine a strategy training intervention - Problem-Solving Training (PST) - that promotes self-efficacy and reduces caregiver burden and depressive symptoms. Previous research supports efficacy of PST; however, we do not know exactly how many PST sessions are needed or if post-training "boosters" are required to maintain PST benefits. Additionally, we translated and culturally-adapted PST into "Descubriendo Soluciones Juntos" (DSJ), our novel intervention for Spanish-speaking caregivers. METHOD In this 2 × 2 factorial design randomized controlled trial, we will test remotely-delivered PST/DSJ sessions for both English- and Spanish-speaking caregivers of persons with ADRD to determine the optimal number of PST/DSJ sessions and ongoing "booster" sessions needed to best help caregivers navigate their current and future needs. AIMS 1) Compare the efficacy of three vs. six PST/DSJ sessions each with and without booster sessions for decreasing caregiver burden and depression and enhancing caregiver problem-solving; 2) Identify key factors associated with efficacy of PST/DSJ, including age, gender, primary language, relationship to care recipient, and uptake of the PST/DSJ strategy. RESULTS These results will establish guidelines needed for an evidence-based, culturally-adapted, and implementable problem-solving intervention to reduce caregiver stress and burden and improve caregiver health and well-being. CONCLUSION This work promotes inclusion of diverse and underserved populations and advances therapeutic behavioral interventions that improve the lives of caregivers of individuals with chronic conditions.
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Affiliation(s)
- ShannonB Juengst
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America; Department of Applied Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America.
| | - Charlene Supnet
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Chung Lin Novelle Kew
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America; Department of Applied Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Valeria Silva
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Marlene Vega
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America; Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Gang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America; Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America
| | - Brendan Kelley
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America; Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America
| | - Gladys Maestre
- School of Medicine, University of Texas Rio Grande Valley, One West University Boulevard, Brownsville, TX 78520, United States of America
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Manis DR, Rahim A, Poss JW, Bielska IA, Bronskill SE, Tarride JÉ, Abelson J, Costa AP. Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada. BMC Geriatr 2021; 21:463. [PMID: 34399694 PMCID: PMC8365888 DOI: 10.1186/s12877-021-02400-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/29/2021] [Accepted: 07/24/2021] [Indexed: 02/23/2023] Open
Abstract
Background Many residents of assisted living facilities live with dementia, but little is known about the characteristics of assisted living facilities that provide specialized care for older adults who live with dementia. In this study, we identify the characteristics of assisted living facilities that offer a dementia care program, compared to those that do not offer such a program. Methods We conducted a population-level cross-sectional study on all licensed assisted living facilities in Ontario, Canada in 2018 (n = 738). Facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of the other 12 provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program. Results There were 123 assisted living facilities that offered a dementia care program (16.7% versus 83.3% no dementia care). Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7% versus 21.6% no dementia care) and more than 115 suites (46.3% versus 20.8% no dementia care). All assisted living facilities that offered a dementia care program also offered nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjustment for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding (Prevalence Ratio [PR] 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that offered medical services (PR 1.78, 95% CI 1.00 to 3.17), compared to those that did not. Conclusions A dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and offered at least five of the other 12 regulated care services. Our findings deepen the understanding of specialized care for dementia in assisted living facilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02400-w.
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Affiliation(s)
- Derek R Manis
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada. .,ICES, Toronto, Ontario, Canada.
| | | | - Jeffrey W Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Iwona A Bielska
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jean-Éric Tarride
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada
| | - Julia Abelson
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada
| | - Andrew P Costa
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,ICES, Toronto, Ontario, Canada.,Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada.,Schlegel Research Institute for Aging, Waterloo, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Gilbert AS, Antoniades J, Croy S, Brijnath B. "The mind may go, but the heart knows": Emotional care by ethnic minority carers of people living with dementia. Soc Sci Med 2021; 285:114294. [PMID: 34365072 DOI: 10.1016/j.socscimed.2021.114294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022]
Abstract
Drawing on the sociology of emotions, this article investigates the socially and culturally mediated nature of emotions and emotional care within 93 ethnic minority carers' narratives of dementia care. Adding to the cross-cultural literatures on the sociology of emotions and dementia care respectively, our analysis showed that 'signals' of dementia to family carers were often emotional outbursts of anger by the person with dementia. These displays, in turn, created conflict, and aroused emotions such as shame, anger, and depression among carers. To mitigate these tendencies, carers enacted emotional management, which centered on reducing the gravity of negative emotions felt by the person with dementia, and affording them the social space to maintain a positive disposition. To create this positive emotional space, carers deployed different strategies. Some mobilized medical discourses to diffuse the emotional and moral significance of their relative's behavior and enable emotional distantiation. Others conceived of people with dementia as 'childlike' and requiring their protection from emotional negativity. Although, such efforts work took a toll on carers' emotional energies, it was considered enabling, therapeutic, and integral to care. Such emotional work departs from academic and advocacy efforts that see such behavior as patronizing and infantilizing, and underscores the need for more nuanced discussion around emotions and dementia care in ethnic minority families.
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Manis DR, Rahim A, Poss JW, Bielska IA, Bronskill SE, Tarride JÉ, Abelson J, Costa AP. Association Between Dementia Care Programs in Assisted Living Facilities and Transitions to Nursing Homes in Ontario, Canada: A Population-Based Cohort Study. J Am Med Dir Assoc 2021:S1525-8610(21)00640-X. [PMID: 34352202 DOI: 10.1016/j.jamda.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/25/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigate whether older adults who were newly diagnosed with dementia (severity unspecified) and resided in an assisted living facility that offered a dementia care program had a lower rate of transition to a nursing home, compared to those who resided in an assisted living facility without such a program. DESIGN Population-based retrospective cohort study. SETTING AND PARTICIPANTS Linked, person-level health system administrative data on older adults who were newly diagnosed with dementia and resided in an assisted living facility in Ontario, Canada, from 2014 to 2019 (n = 977). METHODS Access to a dementia care program in an assisted living facility (n = 57) was examined. Multivariable Cox proportional hazards regression with robust standard errors clustered on the assisted living facility was used to model the time to transition to a nursing home from the new dementia diagnosis. RESULTS There were 11.8 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility with a dementia care program, compared with 20.5 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility without a dementia care program. After adjustment for relevant characteristics at baseline, older adults who resided in an assisted living facility with a dementia care program had a 40% lower rate of transition to a nursing home (hazard ratio 0.60, 95% confidence interval 0.44, 0.81), compared with those in an assisted living facility without such a program at any point during the follow-up period. CONCLUSIONS AND IMPLICATIONS The rate of transition to a nursing home was significantly lower among older adults who resided in an assisted living facility that offered a dementia care program. These findings support the expansion of dementia care programs in assisted living facilities.
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Hopkinson J, King A, Young L, McEwan K, Elliott F, Hydon K, Muthukrishnan S, Tope R, Veitch AM, Howells C, Hoskins M. Crisis management for people with dementia at home: Mixed-methods case study research to identify critical factors for successful home treatment. Health Soc Care Community 2021; 29:1072-1082. [PMID: 32856348 DOI: 10.1111/hsc.13141] [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] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 05/04/2023]
Abstract
Best practice in dementia care is support in the home. Yet, crisis is common and can often result in hospital admission with adverse consequences. The objective of this mixed-methods case study research was to identify the critical factors for resolving crisis for a person with dementia living at home. The research was an in-depth investigation of what happens during crisis for people with dementia and how it is managed by a Home Treatment Crisis Team to resolution and outcome at 6 weeks and 6 months. The methods were; observation of crisis management for 15 patients with dementia (max three observations per patient, total 41), interviews with patients with dementia (n = 5), carers (n = 13) and professionals (n = 14, range one to six interviews per person, total 29), focus group (nine professionals), and extraction of demographics and medical history from medical records. Analysis focused on the identification of factors important for crisis resolution and avoidance of hospital admission. Critical factors for the Home Treatment Crisis Team to enable successful crisis resolution were: immediate action to reduce risk of harm, expertise in dementia care and carer education, communication skills to establish trust and promote benefits of home treatment, shared decision-making, medication management, addressing the needs of carers independently of the person with dementia and, local availability of respite and other community services. The Home Treatment Crisis Team integrated the seven factors to deploy a biopsychosocial systems approach with embedded respect for personhood. This approach enabled crisis resolution for a person with dementia by creating a system of services, treatments, resources and relationships, 'Safe Dementia Space', in the community with avoidance of hospital admission in more than 80% of referrals. The identified critical factors for crisis resolution are important considerations in the design and delivery of home treatment services for people with dementia.
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Affiliation(s)
- Jane Hopkinson
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Amanda King
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Lucy Young
- Elysium Healthcare, Ty Gwyn Hall, Abergavenny, UK
| | - Kirsten McEwan
- University of Derby, Centre for Health and Social Care Research, Derby, UK
| | - Fiona Elliott
- Aneurin Bevin University Health Board, Serennu Children's Centre, Newport, UK
| | - Kate Hydon
- Avon and Wiltshire Mental Health Partnership, NHS Trust, Bristol, UK
| | | | | | - Anne-Marie Veitch
- Mental Health Services for Older People, Cardiff & Vale University Health Board, Cardiff, UK
| | - Cristie Howells
- Mental Health Services for Older People, Cardiff & Vale University Health Board, Cardiff, UK
| | - Mathew Hoskins
- Mental Health Services for Older People, Cardiff & Vale University Health Board, Cardiff, UK
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
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Chulakadabba K, Muangpaisan W, Siritipakorn P, Wongviriyawong T, Suraarunsumrit P, Chalermsri C, Intalapaporn S, Chatthanawaree W, Srinonprasert V, Assantachai P. Characteristics and Real-Life Outcomes of Dementia and Cognitive Impairment at a Geriatric Clinic. Dement Geriatr Cogn Disord 2021; 49:312-320. [PMID: 33075794 DOI: 10.1159/000509731] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Various patterns of dementia care have been developed in different settings, depending on the availability of healthcare resources and facilities. The purpose of this study was to examine the epidemiology and characteristics of dementia care at a geriatric clinic, a field that has been subject to little prior evaluation. METHODS A retrospective chart review was undertaken of cohort patients with cognitive impairment who had received a diagnosis and were still on active follow-up at a geriatric clinic. A total of 892 patients were included. In addition, 203 geriatric patients with no cognitive impairment who attended the clinic during the study period were sampled as a control. RESULTS The main diagnoses of dementia were Alzheimer's disease (AD) (40.1%), vascular dementia (16.9%), unspecified dementia (16.3%), mixed dementia (9.0%), AD with cerebrovascular disease (8.7%), and Parkinson's disease dementia (6.1%). Atypical dementia was presented in 3.0% of cases. There were 178 patients with mild cognitive impairment, 20 with vascular cognitive impairment, and 18 with subjective cognitive decline. Other comorbidities were found in 97% of the subjects. Patients with cognitive impairment had a higher total number of other geriatric syndromes and higher percentages for delirium, falls, immobility, loss of appetite, and incontinence. Potentially reversible causes of dementia were found in 11.3% of the cases. Acetylcholinesterase inhibitors were administered to 61%, whereas 23.5% received an NMDA receptor antagonist. The need for a change in the antidementia medication was identified for 10.7% of the subjects; the major cause was adverse drug side effects. Nonpharmacological therapy only was administered to 52.4% of the people with dementia who had behavioral and psychological symptoms. CONCLUSIONS Mixed brain pathologies, comorbidities, and the coexistence of other geriatric syndromes are common at geriatric clinics. Holistic, integrated, and continuous care are needed to improve the outcomes of patients with more complicated comorbidities.
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Affiliation(s)
- Kritapas Chulakadabba
- Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weerasak Muangpaisan
- Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand,
| | - Pitiporn Siritipakorn
- Department of Nursing, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Titima Wongviriyawong
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patumporn Suraarunsumrit
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalobol Chalermsri
- Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somboon Intalapaporn
- Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wichai Chatthanawaree
- Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varalak Srinonprasert
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prasert Assantachai
- Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Gibson C, Goeman D, Hutchinson A, Yates M, Pond D. The provision of dementia care in general practice: practice nurse perceptions of their role. BMC Fam Pract 2021; 22:110. [PMID: 34107867 PMCID: PMC8191039 DOI: 10.1186/s12875-021-01467-z] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
Background Primary care nurses can assist General Practitioner’s to identify cognition concerns and support patient health self-management for those experiencing cognitive impairment or dementia. This support may lead to more appropriate care and better health outcomes for this group. Consequently, there is a need to identify the role of the primary care nurse in dementia care provision, nurse perceptions of this role and to also understand the barriers and enablers that may influence any current or potential primary care nurse role in dementia care provision. Methods Eight focus groups were conducted with a total of 36 primary care nurses. Data was transcribed verbatim and thematically analysed. Results There was a high level of agreement between primary care nurses that they had a role in provision of dementia care. This role was largely attributed to the strong therapeutic relationship between nurses and patients. However, dementia care provision was not without its challenges, including a perceived lack of knowledge, limited resources and the hierarchical nature of general practice. Three main themes were identified: personal attributes of the primary care nurse; professional attributes of the primary care nurse role and the context of practice. Six sub-themes were identified: knowing the person; overcoming stigma; providing holistic care; knowing what to do; team culture and working in the system. Conclusions The findings of this study suggest primary care nurses have a role in dementia care provision and, there is a need to provide support for the nurse to deliver person-centred health care in the context of cognitive impairment. As the demand for good quality primary care for people living with dementia increases, the role of the primary care nurse should be considered in primary care policy discussions. The knowledge gained from this study could be useful in informing dementia training content, to provide better prompts in the health assessment and care planning templates used by primary care nurses to better identify the care needs of people with a cognitive impairment and to develop dementia care guidelines for primary care nurses.
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Affiliation(s)
- Caroline Gibson
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Melbourne, Australia.
| | - Dianne Goeman
- Faculty of Health and Medicine, School of Medicine and Public Health, Central Clinical School, University of Newcastle, Monash University, Melbourne, Australia
| | - Alison Hutchinson
- School of Nursing and Midwifery, Monash HealthCentre for Quality and Patient Safety ResearchInstitute for Health Transformation, Deakin University, Melbourne, Australia
| | - Mark Yates
- Deakin University School of Medicine, Ballarat Health Services, Melbourne, Australia
| | - Dimity Pond
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Melbourne, Australia
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Paananen J, Rannikko J, Harju M, Pirhonen J. The impact of Covid-19-related distancing on the well-being of nursing home residents and their family members: a qualitative study. Int J Nurs Stud Adv 2021; 3:100031. [PMID: 34095858 PMCID: PMC8166157 DOI: 10.1016/j.ijnsa.2021.100031] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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: 03/25/2021] [Revised: 05/04/2021] [Accepted: 05/21/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of this study is to examine the consequences of Covid-19-related isolation and social restrictions on the well-being of nursing home residents and their family members, and to analyze how distancing has affected the relationships of family members with residents and the nursing home staff. DESIGN The data consist of 41 thematic one-on-one interviews conducted during May-December 2020 with family members of nursing home residents. Convenience sampling was utilized by asking several nursing homes in different parts of Finland to relay a contact request from the researchers to the residents' family members. The main themes of the interviews were lockdown and visiting restrictions. Subthemes included the frequency of visits, other means of interaction, changes in the relationships of family members with their loved ones and with nursing home staff, and the feelings aroused by the situation. The interviews were audio recorded and transcribed verbatim, resulting in 794 pages of data. METHOD The qualitative study uses inductive content analysis. NVivo12 software facilitated the systematic coding of the data. RESULTS According to the family members, distancing aggravated the residents' pre-existing conditions: they reported a sudden progression in memory disorders and significant deterioration in physical abilities, for example. Both residents and family members experienced anxiety, grief, and severe stress, and family members expressed concern that residents might die due to a lack of social contact and activity. Family members were also frustrated about not being able to touch their relatives or participate in their care, and therefore sometimes thought that their visits were useless. New forms of interaction with family members, introduced by the nursing homes, were appreciated. However, some family members perceived the interactional protocols as unfair and complained about insufficient information. CONCLUSIONS The findings underline the need for nursing homes to implement a good interactional protocol. Overall, the results show that the measures taken to protect residents' health during the Covid-19 outbreak were short-sighted in terms of the social dimension of well-being. It is therefore important to continue developing safe and humane solutions for interaction when social restrictions are in place. Tweetable abstract: Covid-19-related distancing has caused anxiety, grief, and severe stress for nursing home residents and their family members.
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Affiliation(s)
- Jenny Paananen
- Department of Nursing Science, University of Turku, 20014, Finland
| | - Johanna Rannikko
- Department of Nursing Science, University of Turku, 20014, Finland
| | - Maija Harju
- Faculty of Social Sciences, University of Helsinki, P.O Box 9, 00014, Finland
| | - Jari Pirhonen
- Faculty of Social Sciences, University of Helsinki, P.O Box 9, 00014, Finland
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Dobbs D, Zimmerman S, Carder P, Beeber AS, Palmertree SJ. Staff Reports of Behavioral Expressions of Persons with Dementia in 250 Assisted Living Communities. Gerontologist 2021; 62:169-180. [PMID: 33993241 DOI: 10.1093/geront/gnab059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Assisted living (AL) residents with dementia commonly exhibit behavioral expressions (BEs), yet no study has examined how AL staff perceive of and respond to BEs in terms of the "ABC" model of antecedents, behaviors and consequences, or how perceptions relate to organizational characteristics. Understanding staff perceptions may inform interventions. RESEARCH DESIGN AND METHODS A convergent, mixed-methods design was used in a study of health care supervisors from 250 AL communities in seven states who reported 366 cases of resident BEs (one successful and one unsuccessful case). Qualitative analysis identified antecedents, BEs, staff responses, resident outcomes, and disposition (aging in place or discharge). Content analysis identified themes and compared case types. Descriptive statistics examined organizational characteristics associated with identifying antecedents. RESULTS One-quarter of cases recognized antecedents; slightly more were identified in successful (28%) compared to unsuccessful cases (20%); staff in dementia-only and smaller communities identified antecedents more often. Combativeness and anxiety were the most frequently reported BEs. The majority of both types of cases reported staff responses. Medication management was enacted as a response in 40% of cases compared to psychiatric assessment in 33% of cases. DISCUSSION AND IMPLICATIONS Staff training is indicated to increase AL staff recognition of antecedents; doing so might reduce use of antipsychotic medications. Psychiatric assessment plays an important role in dementia care in AL and warrants further examination. Results could be helpful for applied behavioral researchers interested in developing ways to improve identification of antecedents of BEs of persons with dementia.
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Affiliation(s)
- Debra Dobbs
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paula Carder
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA
| | - Anna S Beeber
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephanie J Palmertree
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Cohen-Mansfield J. The Rights of Persons With Dementia and Their Meanings. J Am Med Dir Assoc 2021; 22:1381-5. [PMID: 33844989 DOI: 10.1016/j.jamda.2021.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/23/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022]
Abstract
Concern about the lack of human rights afforded to persons living with dementia has emerged in recent years. Although the literature addresses certain rights, it does not include a holistic framework of rights in terms of the lived experience of older persons with cognitive impairment. Inspired by the 20 rights advocated for children by physician-educator Janusz Korczak, this article analyzes his formulation of rights in the context of persons with dementia, linking them to the ethical principles of Beneficence, Autonomy, and Justice. The analysis thus provides a holistic framework for addressing the human rights of persons with dementia, and their meanings for the lived experiences of persons with dementia and their caregivers. It offers new insights into the philosophy and practice of care, with implications for dementia care research, public health policy, practice guidelines for health care professionals, and the instruction of family and other caregivers of persons with dementia.
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Hartung B, Lalonde M, Vanderspank-Wright B, Phillips JC. New graduate nurses and dementia care in acute care: A qualitative study. Nurse Educ Pract 2021; 53:103049. [PMID: 33992877 DOI: 10.1016/j.nepr.2021.103049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/20/2019] [Revised: 03/01/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Abstract
With the increasing older adult population, new graduate nurses will be providing care for patients with dementia more frequently. The purpose of this qualitative study was to explore the experiences of new graduate nurses when providing care for patients with dementia in acute care environments. We conducted semi-structured interviews with eleven new graduate nurses in Ontario, Canada. Three themes emerged from the thematic analysis: (1) building of vision and values; (2) clashing of vision and values; and (3) making do with what you have. Barriers to providing dementia care in acute care were similar to barriers experienced by non- new graduate nurses reported in the literature, such as challenges with responsive behaviours, maintaining safety and providing psychosocial care. Facilitators identified were supportive colleagues and early exposure to dementia care.
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Affiliation(s)
- Benjamin Hartung
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road Ottawa, ON K1H 8M5 Canada.
| | - Michelle Lalonde
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road Ottawa, ON K1H 8M5 Canada.
| | - Brandi Vanderspank-Wright
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road Ottawa, ON K1H 8M5 Canada.
| | - J Craig Phillips
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road Ottawa, ON K1H 8M5 Canada.
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50
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Saadi JP, Carr E, Fleischmann M, Murray E, Head J, Steptoe A, Hackett RA, Xue B, Cadar D. The role of loneliness in the development of depressive symptoms among partnered dementia caregivers: Evidence from the English Longitudinal Study of Aging. Eur Psychiatry 2021; 64:e28. [PMID: 33766187 PMCID: PMC8080187 DOI: 10.1192/j.eurpsy.2021.20] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Depressive symptoms are highly prevalent among partnered dementia caregivers, but the mechanisms are unclear. This study examined the mediating role of loneliness in the association between dementia and other types of care on subsequent depressive symptoms. Methods Prospective data from partnered caregivers were drawn from the English Longitudinal Study of Aging. The sample consisted of 4,672 partnered adults aged 50–70 living in England and Wales, followed up between 2006–2007 and 2014–2015. Caregiving was assessed across waves 3 (2006–2007), 4 (2008–2009), and 5 (2010–2011), loneliness at wave 6 (2012–2013), and subsequent depressive symptoms at wave 7 (2014–15). Multivariable logistic regression models were used to assess the association between caregiving for dementia and depressive symptoms compared to caregiving for other illnesses (e.g., diabetes, coronary heart disease (CHD), cancer, and stroke). Binary mediation analysis was used to estimate the indirect effects of caregiving on depressive symptoms via loneliness. Results Care for a partner with dementia was associated with higher odds of depressive symptoms at follow-up compared to those not caring for a partner at all (odds ratio [OR] = 2.6, 95% confidence intervals [CI]: 1.4, 5.1). This association was partially mediated by loneliness (34%). Care for a partner with other conditions was also associated with higher odds of depressive symptoms compared to non-caregiving partners (OR = 1.7, 95% CI: 1.2, 2.5), but there was no evidence of an indirect pathway via loneliness. Conclusion Loneliness represents an important contributor to the relationship between dementia caregiving and subsequent depressive symptoms; therefore, interventions to reduce loneliness among partnered dementia caregivers should be considered.
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Affiliation(s)
- J P Saadi
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - E Carr
- Department of Epidemiology and Public Health, University College London, London, United Kingdom.,Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - M Fleischmann
- Faculty of Science, Methodology and Applied Biostatistics, University of Amsterdam, Amsterdam, The Netherlands
| | - E Murray
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - J Head
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - A Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - R A Hackett
- Department of Behavioural Science and Health, University College London, London, United Kingdom.,Department of Psychology, King's College London, London, United Kingdom
| | - B Xue
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - D Cadar
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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