-
Aging & Mental Health Mar 2023With a lack of existing comprehensive reviews, the aim of this mixed-method systematic review was to synthesise the evidence on the early impacts of the pandemic on...
OBJECTIVES
With a lack of existing comprehensive reviews, the aim of this mixed-method systematic review was to synthesise the evidence on the early impacts of the pandemic on unpaid dementia carers across the globe.
METHODS
This review was registered on PROSPERO [CDR42021248050]. PubMed, CINAHL, Embase, Scopus and Web of Science were searched from 2020 to July 2021. Studies were included if they reported on the different impacts of the pandemic on unpaid dementia carers aged 18+, with papers published in English, German, Polish, or Spanish. A number of research team members were involved in the selection of studies following PRISMA guidance.
RESULTS
Thirty-six studies (43 papers) from 18 countries reported on the early impact of the pandemic on unpaid dementia carers. Impacts were noted on accessing care and support; carer burden; and well-being. Studies found that carers had limited access to care and support services, increased workload, enhanced feelings of social isolation, and reduced wellbeing. Specifically, reductions in access to care and support increased carer's unpaid caring tasks, removing any opportunities for temporary respite, and thus further increasing carer burden and reducing mental well-being in many.
CONCLUSIONS
The needs of unpaid dementia carers appear to have increased during the pandemic, without adequate support provided. Policy initiatives need to enable better mental health support and formal care provision for unpaid carers and their relatives with dementia, whilst future research needs to explore the long-term implications of carer needs in light of care home restrictions and care delivery.
Topics: Humans; Caregivers; COVID-19; Dementia; Mental Health; Palliative Care
PubMed: 35818800
DOI: 10.1080/13607863.2022.2084510 -
Journal of General Internal Medicine Jul 2020With continued growth in the older adult population, US federal and state costs for long-term care services are projected to increase. Recent policy changes have shifted...
BACKGROUND
With continued growth in the older adult population, US federal and state costs for long-term care services are projected to increase. Recent policy changes have shifted funding to home and community-based services (HCBS), but it remains unclear whether HCBS can prevent or delay long-term nursing home placement (NHP).
METHODS
We searched MEDLINE (OVID), Sociological Abstracts, PsycINFO, CINAHL, and Embase (from inception through September 2018); and Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database, AHRQ Evidence-based Practice Center, and VA Evidence Synthesis Program reports (from inception through November 2018) for English-language systematic reviews. We also sought expert referrals. Eligible reviews addressed HCBS for community-dwelling adults with, or at risk of developing, physical and/or cognitive impairments. Two individuals rated quality (using modified AMSTAR 2) and abstracted review characteristics, including definition of NHP and interventions. From a prioritized subset of the highest-quality and most recent reviews, we abstracted intervention effects and strength of evidence (as reported by review authors).
RESULTS
Of 47 eligible reviews, most focused on caregiver support (n = 10), respite care and adult day programs (n = 9), case management (n = 8), and preventive home visits (n = 6). Among 20 prioritized reviews, 12 exclusively included randomized controlled trials, while the rest also included observational studies. Prioritized reviews found no overall benefit or inconsistent effects for caregiver support (n = 2), respite care and adult day programs (n = 3), case management (n = 4), and preventive home visits (n = 2). For caregiver support, case management, and preventive home visits, some reviews highlighted that a few studies of higher-intensity models reduced NHP. Reviews on other interventions (n = 9) generally found a lack of evidence examining NHP.
DISCUSSION
Evidence indicated no benefit or inconsistent effects of HCBS in preventing or delaying NHP. Demonstration of substantial impacts on NHP may require longer-term studies of higher-intensity interventions that can be adapted for a variety of settings. Registration PROSPERO # CRD42018116198.
Topics: Aged; Case Management; Humans; Independent Living; Nursing Homes; Skilled Nursing Facilities; Systematic Reviews as Topic
PubMed: 31898134
DOI: 10.1007/s11606-019-05568-5 -
The Gerontologist Jun 2024Self-direction is an approach that allows older adults and people with disabilities to determine the home and community-based services they receive, including the...
BACKGROUND AND OBJECTIVES
Self-direction is an approach that allows older adults and people with disabilities to determine the home and community-based services they receive, including the ability to hire caregivers of their choice. Self-direction has been shown to improve outcomes for the service recipients. The promotion of choice and control in self-direction may also affect family caregivers. We conducted a systematic review examining the impact of self-direction on a broad range of caregiver outcomes.
RESEARCH DESIGN AND METHODS
We conducted a systematic review guided by PRISMA guidelines. Literature search was conducted in 8 databases. We appraised risk of bias using the Joanna Briggs Institute critical appraisal checklists and assessed certainty of evidence using the GRADE framework.
RESULTS
Sixteen studies meeting inclusion criteria were included. We found, with moderate certainty, that self-direction is associated with improved caregivers' personal and social wellbeing. Caregivers also reported reduced unmet needs and increased access to care for the care recipients under self-direction. Self-direction did not appear to reduce caregiving hours. With less certainty, self-direction was also positively associated with increased respite care use, perception of choice, and intention to continue caregiving by caregivers.
DISCUSSION AND IMPLICATIONS
Beyond delivering person-centered services that improve recipient outcomes, self-direction may also improve the outcomes of family caregivers.
PubMed: 38853407
DOI: 10.1093/geront/gnae068 -
Research in Nursing & Health Feb 2024Psychoeducational videoconferencing interventions bypass traditional in-person barriers to attendance and are effective in improving caregiving skills, self-care, and...
Feasibility, usability, and acceptability of psychoeducational videoconferencing interventions for informal caregivers: A systematic review of randomized controlled trials.
Psychoeducational videoconferencing interventions bypass traditional in-person barriers to attendance and are effective in improving caregiving skills, self-care, and wellness among informal caregivers. Information on their feasibility, usability, and acceptability from the caregivers' perspective is needed to inform future designs and developments. This systematic review follows PRISMA 2020 guidelines to integrate this information. Five databases were systematically searched for relevant randomized control trials published between January 2012 and December 2022. Reference lists were cross-checked for additional studies. Relevant studies were appraised and had their data extracted. This review contains 14 randomized controlled trials. Retention rates ranged from 55.56% to 100%, and major reasons for withdrawing include deteriorating patient health, lack of interest, and technical difficulties (feasibility). Caregivers found the videoconference technology usable, although participants in one intervention experienced poor connectivity and persistent technical issues (usability). Most caregivers were satisfied with videoconferencing interventions, found their content applicable to their situation, and appreciated their structure (acceptability). Those in videoconferencing group interventions were satisfied with small caregiver group sizes (acceptability). Adding respite care to interventions and incorporating short and regular videoconferencing sessions may improve feasibility. Ensuring small group sizes in videoconferencing group interventions and using participatory design may enhance acceptability. Advocacy is needed for employees identifying as informal caregivers to receive employer support and for quality connectivity within underserved areas. This may improve the feasibility and usability of interventions, allowing caregivers to receive the support they need. In future studies, power analyses and recruiting more caregivers may better assess feasibility.
Topics: Humans; Caregivers; Feasibility Studies; Randomized Controlled Trials as Topic; Videoconferencing; Personal Satisfaction
PubMed: 38069607
DOI: 10.1002/nur.22358 -
Drugs & Aging Dec 2023There has been considerable focus on the use of psychotropic agents in people living with dementia in long-term care. However, psychotropic use often commences well... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There has been considerable focus on the use of psychotropic agents in people living with dementia in long-term care. However, psychotropic use often commences well before transitioning to long-term care.
OBJECTIVES
To synthesize the available literature to identify factors associated with psychotropic medication use in people living with dementia in the community.
METHODS
This PROSPERO-registered review reports findings from a comprehensive search of Embase, PsycINFO, and PubMed (including MEDLINE) databases according to predefined inclusion and exclusion criteria (2010-2022). Inclusion criteria were original prospective or retrospective design research papers enrolling people diagnosed with dementia utilizing a psychotropic medication and living at home. Quality and risk of bias was assessed Newcastle-Ottawa Quality Assessment Scale. The last search was conducted in November 2022. Thematic analysis was used to synthesize the emergent factors identified, and a meta-analysis was undertaken on suitable data.
RESULTS
The search identified 619 articles. After review and exclusions, 39 articles were included for synthesis, including 1,338,737 people. The majority of papers (67%) were rated as low risk of bias and corresponding good quality. Thematic analysis suggested associations between psychotropic prescribing and patient and environmental factors, with little data concerning carer and prescriber factors. Such factors included age (< 75 years, > 90 years), sex, more advanced functional decline, and living alone. Meta-analysis identified significant associations between psychotropic use and respite (temporary full-time care or hospitalization) and comorbid psychiatric illness.
CONCLUSIONS
While it is clear from this review that there remains a significant lack of clarity as to the reasons why these medications are being utilized in this population, this review provides greater insight and understanding into the context of psychotropic use. The study has highlighted an opportunity for further targeted research to be conducted and provides a much-needed context for this to occur.
PROSPERO REGISTRATION NUMBER
CRD42021286322.
Topics: Humans; Aged; Dementia; Prospective Studies; Retrospective Studies; Psychotropic Drugs
PubMed: 37943474
DOI: 10.1007/s40266-023-01070-0 -
BMJ Open Mar 2024Mental health inpatient facilities are increasingly focusing on creating therapeutic, person-centred care environments. However, research shows that this focus may have...
OBJECTIVES
Mental health inpatient facilities are increasingly focusing on creating therapeutic, person-centred care environments. However, research shows that this focus may have unintended consequences for healthcare staff. Designs that do not pay attention to staff needs may risk contributing to stress, burnout, job dissatisfaction and mental exhaustion in the work environment. This systematic review aims to identify and synthesise current research on the design factors of adult mental health inpatient facilities that impact healthcare staff.
DESIGN
A mixed method systematic review was conducted to search for empirical, peer-reviewed studies using the databases CINAHL, Embase, PsycINFO, PubMed and Web of Science from their inception up to 5 September 2023. The Joanna Briggs Institute's critical appraisal checklists were used to assess the methodological quality of the eligible studies. Data were extracted and grouped based on the facility design factors.
RESULTS
In our review, we included 29 peer-reviewed empirical studies that identified crucial design factors impacting healthcare staff in adult mental health inpatient facilities. Key factors included layouts providing optimal visibility, designated work and respite areas, and centrally located nursing stations. Notably, mixed perceptions regarding the benefits and challenges of open and glass-enclosed nursing stations suggest areas requiring further research. Facilities in geographically remote locations also emerged as a factor influencing staff dynamics. Additionally, although only supported by a limited number of studies, the significance of artwork, sensory rooms for respite, appropriate furniture and equipment, and access to alarms was acknowledged as contributory factors.
CONCLUSION
Through the synthesis of existing research, this review identified that the design of mental health facilities significantly impacts staff well-being, satisfaction, performance and perception of safety. Concluding that, in order to create a well-designed therapeutic environment, it is essential to account for both service users and staff user needs.
PROSPERO REGISTRATION NUMBER
CRD42022368155.
Topics: Adult; Humans; Delivery of Health Care; Hospitals, Psychiatric; Inpatients; Mental Health; Health Personnel; Facility Design and Construction
PubMed: 38448069
DOI: 10.1136/bmjopen-2023-074368