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Tidsskrift For Den Norske Laegeforening... Jun 2011It is estimated that 1,200 people under the age of 65 have been diagnosed with dementia in Norway. This article provides an overview of the types of dementia frequently... (Review)
Review
BACKGROUND
It is estimated that 1,200 people under the age of 65 have been diagnosed with dementia in Norway. This article provides an overview of the types of dementia frequently seen in younger patients.
MATERIAL AND METHODS
The article is based on a non-systematic search in PubMed, as well as the authors' own clinical and research experience.
RESULTS
Alzheimer's disease, frontotemporal dementia, vascular dementia and dementia with Lewy bodies, are the most common types of dementia occurring more often in younger than in older patients. The cognitive symptoms are more variable in younger patients than in older. Only a small percentage of early onset dementia is caused by genetic factors. There are few diagnostic tools available for this age group and it takes considerable time to reach a correct diagnosis. Early diagnosis allows the patient and carer to plan for the future.
INTERPRETATION
Physicians should be aware that dementia can occur in younger people, and more diagnostic assessments should be developed for this patient group. Better coordination from the public health authority and municipalities is needed to provide respite care for early onset dementia patients and their carers.
Topics: Adult; Age of Onset; Alzheimer Disease; Dementia; Dementia, Vascular; Early Diagnosis; Genetic Predisposition to Disease; Humans; Lewy Body Disease; Life Style; Middle Aged; Norway; Prognosis; Risk Factors
PubMed: 21694746
DOI: 10.4045/tidsskr.09.0845 -
American Journal of Alzheimer's Disease... May 2011Dementia is a complicated disease requiring medical, psychological, and social services. Services to address these needs include medical care (outpatient... (Review)
Review
Dementia is a complicated disease requiring medical, psychological, and social services. Services to address these needs include medical care (outpatient physician/specialist, inpatient, emergency) and community care (home health, day care, meal preparation, transportation, counseling, support groups, respite care, physical therapy). This systematic review of articles published in English from 1991 to the present examines studies of ambulatory, community-dwelling dementia patients with established dementia diagnoses. Searches of the Medline database using 13 combinations of search terms, plus searches of Embase and PsycINFO databases using 3 combinations of terms and examination of reference lists of related articles, resulted in identification of 15 studies dealing with healthcare utilization among community-dwelling dementia patients in both medical and community care settings. Patients with dementia frequently use the full spectrum of medical services. Community resources are used less frequently. Community healthcare services may be a valuable resource in alleviating some burden of dementia care for physicians.
Topics: Aged; Ambulatory Care; Community Health Services; Community Mental Health Services; Comprehensive Health Care; Delivery of Health Care; Dementia; Health Services for the Aged; Humans; Independent Living; Referral and Consultation; Social Welfare; United States; Utilization Review
PubMed: 21273207
DOI: 10.1177/1533317510392564 -
Archives of Public Health = Archives... 2018Due to the increase in the number of people with dementia, relatives often provide in-home care. This care constitutes a cornerstone of the healthcare system, and... (Review)
Review
BACKGROUND
Due to the increase in the number of people with dementia, relatives often provide in-home care. This care constitutes a cornerstone of the healthcare system, and maintaining these caregivers' well-being is therefore of paramount importance. Although respite interventions are generally considered an effective support system, they tend to be underutilized. The aim of this integrative literature review is to highlight the factors that promote and impede the use of respite interventions.
METHODS
Searches were conducted on the PubMed and CINAHL databases for studies of respite interventions from 1980 to 2016, and they yielded 51 articles of relevance.
RESULTS
Analysis of these articles revealed modifiable and immutable factors that influence the use of respite. The most cited topic categories in the literature were attributes of respite services and workload managed by caregivers, which is characterized by the onset of burden.
CONCLUSION
The factors promoting or impeding the use of respite interventions identified by our analysis highlight the need to adapt respite service attributes and use caregivers' skills to foster the partnership between healthcare teams and caregivers and to ensure the accompanying dyad's quality and safety.
PubMed: 30479766
DOI: 10.1186/s13690-018-0316-y -
BMJ (Clinical Research Ed.) Mar 1993
Topics: Caregivers; Humans; Respite Care; Social Support; United Kingdom
PubMed: 8461829
DOI: 10.1136/bmj.306.6878.649-a -
Journal of the American Geriatrics... Feb 2007The proportion of frail elderly people in the industrialized world is increasing. Respite care is a potentially important way of maintaining the quality of life for... (Meta-Analysis)
Meta-Analysis Review
The proportion of frail elderly people in the industrialized world is increasing. Respite care is a potentially important way of maintaining the quality of life for these people and their caregivers. The objective of this systematic review was to determine the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their caregivers. To identify relevant studies, 37 databases were searched, and reference checking and citation searches were undertaken. Well-controlled effectiveness studies were eligible for inclusion, with uncontrolled studies admissible only in the absence of higher-quality evidence. Studies assessed the effect of community-based respite on caregivers of frail elderly people relative to usual care or to another support intervention. Eligible economic evaluations also addressed costs. Where appropriate, data were synthesized using standard meta-analytic techniques. Ten randomized, controlled trials, seven quasi-experimental studies and five uncontrolled studies were included in the review. For all types of respite, the effects upon caregivers were generally small, with better-controlled studies finding modest benefits only for certain subgroups, although many studies reported high levels of caregiver satisfaction. No reliable evidence was found that respite care delays entry to residential care or adversely affects frail older people. The economic evaluations all assessed day care, which tended to be associated with similar or higher costs than usual care. Given the increasing numbers of frail elderly people and the lack of up-to-date, good-quality evidence for all types of respite care, better-quality evidence is urgently needed to inform current policy and practice.
Topics: Aged; Aged, 80 and over; Caregivers; Cost-Benefit Analysis; Frail Elderly; Humans; Randomized Controlled Trials as Topic; Respite Care
PubMed: 17302669
DOI: 10.1111/j.1532-5415.2006.01037.x -
Dementia (London, England) Aug 2022Though many studies have examined the service utilization of dementia caregivers, there is limited empirical evidence from Asian Americans in this field. Guided by...
BACKGROUND AND OBJECTIVES
Though many studies have examined the service utilization of dementia caregivers, there is limited empirical evidence from Asian Americans in this field. Guided by Andersen's behavioral model of health services use, we aimed to understand what factors were associated with utilizing multiple types of services among Chinese American dementia caregivers.
RESEARCH DESIGN AND METHODS
We collected survey data from 134 Chinese dementia caregivers in New York City. Logistic regression models were conducted to test the associations between predisposing, enabling, and need factors and the likelihood of using tangible (home health aide, adult daycare, respite care), educational (lectures and workshops), and psychological (peer support groups and psychological counseling) support services.
RESULTS
Several variables conceptualized by Andersen's model, including caregiver's knowledge about services, caring tasks, length of care and burden, and care recipient's physical and cognitive deteriorations, were significantly associated with higher possibilities of using multiple types of services. Three sociocultural factors-residing in Chinatown, availability of alternative family caregivers, and diagnosis of cognitive deterioration-were also associated with higher likelihood of using educational or psychological services.
DISCUSSION AND IMPLICATIONS
The findings extend the existing literature on service utilization of caregivers by highlighting the importance of distinguishing types of services and considering sociocultural factors in future research and practice.
Topics: Adult; Asian; Caregivers; Counseling; Dementia; Humans; Respite Care
PubMed: 35511805
DOI: 10.1177/14713012221099781 -
The Journal of Nutrition, Health & Aging Feb 2010This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The...
This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert's opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP's intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver's confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a "case finding" strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies 'typical' cases. In typical cases, among older subjects, the diagnosis of "probable AD" can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and "emergency" hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients' right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force.
Topics: Alzheimer Disease; Clinical Competence; Early Diagnosis; Health Services for the Aged; Humans; Interdisciplinary Communication; Patient Care Management; Patient Care Team; Physician's Role; Primary Health Care; Quality of Health Care; Societies
PubMed: 20126959
DOI: 10.1007/s12603-010-0022-0 -
The Canadian Geographer. Geographe... 2022Eldercare and places of eldercare have been radicalized with the advent of COVID-19. Growing concerns about the safety of long-term care homes, coupled with the...
Eldercare and places of eldercare have been radicalized with the advent of COVID-19. Growing concerns about the safety of long-term care homes, coupled with the continuation of stay-at-home orders, mean that carers are reconstructing new meanings and places of care provision. Increasingly for many Canadians, the home is rapidly becoming the nexus of one's domestic, work, and caregiving world. By interviewing working carers (n = 5) living throughout Canada, this study investigates the changing meanings of home as a place for care during the COVID-19 pandemic. Drawing upon lived experiences of informal carers engaged in the workforce, we observe a blurring of spatial and temporal boundaries between places of work and places of care. Specifically, we note that the integration of carescapes and workscapes into a single domain presents both benefits and tensions to carers, such as increased schedule flexibility and disruptions at work, respectively. Parallel to this, we also explore how previous places of safety and respite, such as independent senior residences and long-term care homes, are perceived as sites of danger and anxiety due to the vulnerability of seniors to COVID-19. This dynamic is likely to continue well into the future, as long-term care homes fall out of favour and carers adopt a more integrated approach to caregiving within their daily lives.
PubMed: 35909794
DOI: 10.1111/cag.12740 -
Public Health Nursing (Boston, Mass.) Jan 2021A program evaluation to demonstrate the feasibility of a recuperative care pilot project to address the needs of unhoused individuals.
OBJECTIVE
A program evaluation to demonstrate the feasibility of a recuperative care pilot project to address the needs of unhoused individuals.
DESIGN
The study is a descriptive postprogram evaluation.
SAMPLE
A total of 73 referrals were made to the project with 23 admissions.
MEASURE
Data regarding number and type of referrals for admission, cost of respite care per guest and per day, hospital costs avoided, referrals to community services, and discharge destination were collected.
INTERVENTION
A case management care model was used. The project staff included a public health nurse and an outreach worker.
RESULTS
One local hospital accounted for 65% of all admissions. Admitting diagnoses were abscess/wound care (44%) followed by postsurgery recovery (17%). Housing resources (65%) was a common referral with 22% of guests discharged to stable housing. Actual length of stay exceeded the planned length by an average of 24 days. Total cost per guest per day was $157.45 which is an estimated savings to referring acute care facilities of between $18,000 and $48,000 per day.
CONCLUSIONS
The project demonstrated an ability to provide unhoused individuals a place to recuperate following hospitalization in a cost-effective manner. Challenges and recommendations of the program going forward were identified.
Topics: Aftercare; Cost-Benefit Analysis; Humans; Pilot Projects; Program Evaluation
PubMed: 33190328
DOI: 10.1111/phn.12834 -
BMJ Supportive & Palliative Care Dec 2021Hospice at Home (HAH) services aim to enable patients to be cared for and die at home, if that is their choice and achieve a 'good death'. A national survey, in 2017,...
OBJECTIVE
Hospice at Home (HAH) services aim to enable patients to be cared for and die at home, if that is their choice and achieve a 'good death'. A national survey, in 2017, aimed to describe and compare the features of HAH services and understand key enablers to service provision.
METHODS
Service managers of adult HAH services in the 'Hospice UK' and National Association for Hospice at Home directories within England were invited to participate. Information on service configuration, referral, staffing, finance, care provision and enablers to service provision were collected by telephone interview.
RESULTS
Of 128 services invited, 70 (54.7%) provided data. Great diversity was found. Most services operated in mixed urban/rural (74.3%) and mixed deprivation (77.1%) areas and provided hands-on care (97.1%), symptom assessment and management (91.4%), psychosocial support (94.3%) and respite care (74.3%). Rapid response (within 4 hours) was available in 65.7%; hands-on care 24 hours a day in 52.2%. Charity donations were the main source of funding for 71.2%. Key enablers for service provision included working with local services (eg, district nursing, general practitioner services), integrated health records, funding and anticipatory care planning. Access to timely medication and equipment was critical.
CONCLUSION
There is considerable variation in HAH services in England. Due to this variation it was not possible to categorise services into delivery types. Services work to supplement local care using a flexible approach benefitting from integration and funding. Further work defining service features related to patient and/or carer outcomes would support future service development.
Topics: Adult; Caregivers; England; Home Care Services; Hospice Care; Hospices; Humans
PubMed: 31722982
DOI: 10.1136/bmjspcare-2019-001818