Primary studies included in this systematic review

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A Unique Support Model for Dementia Patients and Their Families in a Tertiary Hospital Setting: Description and Preliminary Data

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Authors Ghatak, Rita
Journal Clinical Gerontologist
Year
Links DOI http://www.tandfonline.com/doi/abs/10.1080/07317115.2011.539512#.VP_C4PmG-So

This article is included in 1 Systematic review Systematic reviews (1 reference)

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Dementia is a disease of great concern, as the deficit in memory and other cognitive functions that characterize this condition leads to a loss of independent function, which in turn has serious impact on individuals, families, and health care systems. Hospitals and clinics in general do not have “support” programs to assist dementia patients and their families. The day-to-day coping with the disease, care planning, and safety of dementia patients is often left to the families or other support networks, with minimal professional assistance. This article profiles the rationale, emergence, and process of a unique dementia support program based on a continuum of care model, started at Stanford University Medical Center under the Aging Adult Services Program. Each patient and family/caregiver is offered (a) comprehensive information, (b) identification of problem areas, (c) discussion about symptom management and interventions via home visits or family meetings, and (d) linkages to resources, legal/financial planning, and community/specialist services. The number of interactions with patient and family can vary and is customized to the patient/family needs. The dementia support program is recognized as a resource and is a part of a set of recommendations routinely sent to families by Stanford's Neurology Department (http://scmd.stanford.edu/) once the diagnosis of dementia has been made. To date, 237 families have been helped since the program's inception in September 2008, and 85 families agreed to participate in a survey to elicit preliminary data about the usefulness of the dementia support program.

Primary study

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Should care managers for older adults be located in primary care? A randomized controlled trial.

Journal Journal of the American Geriatrics Society
Year 2012
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVES: To determine the effect of a primary care-based care management initiative on residential care placement and death in a population of frail older adults referred for needs assessment in New Zealand. DESIGN: Randomized controlled trial with follow-up at 3, 6, 12, 18, and 24 months for residential care placement and mortality. SETTING: Fifty-five family physician practices in New Zealand that established a care management initiative for older adults assessed as being at high risk of residential care placement in 2004 to 2006. PARTICIPANTS: Three hundred fifty-one individuals (243 female, 108 male) aged 65 and older (mean 81) who were assessed as being at risk of permanent residential care placement. INTERVENTIONS: The care management program (Coordinator of Services for Elderly) consisted of a nominated health professional care manager geographically aligned to family physicians housed with the family physician or located nearby. MEASUREMENTS: Rates of permanent residential care placement and mortality. RESULTS: The risk of permanent residential care placement or death was 0.36 for usual care (control group) and 0.26 for the care management initiative, a 10.2% absolute risk reduction, with the majority of the risk reduction seen in residential care placement (control group 0.25, intervention group 0.16). CONCLUSION: A family physician-aligned community care management approach reduces frail older adults' risk of mortality and permanent residential care placement.

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Barriers and facilitators to optimize function and prevent disability worsening: a content analysis of a nurse home visit intervention.

Journal Journal of advanced nursing
Year 2012
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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AIMS: This paper is a report of an analysis of how to better understand the results of the nurse home visit intervention in the Medicare Primary and Consumer-Directed Care Demonstration in terms of facilitators and barriers to disability improvement/maintenance as compared with disability worsening. BACKGROUND: There is a lack of literature describing how nurse home visit interventions are able to maintain/improve disability among older persons with disability. The present study is one of only six reporting beneficial disability outcomes. METHODS: Cases were purposefully sampled to represent change in the disability construct leading to selection of ten cases each of disability maintenance/improvement (no change or decrease in total Activities of Daily Living score from baseline) and worsening (an increase in total Activities of Daily Living score from baseline). Data from nurses' progress notes and case studies (collected in March 1998-June 2002) were analysed using qualitative descriptive analysis (May 2009). These results remain relevant because the present study is one of the few studies to identify select nurse activities instrumental in postponing/minimizing disability worsening. RESULTS/FINDINGS: Three primary themes captured the facilitators and barriers to effective disability maintenance/improvement: (1) building and maintaining patient-centred working relationships, (2) negotiating delivery of intervention components and (3) establishing balance between patients' acute and chronic care needs. Sub-themes illustrate nurse, patient and system factors associated with effective disability maintenance/improvement (e.g. nurse caring, communicating, facilitating interdisciplinary communication) and barriers associated with disability worsening (e.g. dementia, depression and recurring acute illnesses). CONCLUSION: This study provides new insights about the facilitators and barriers to effective disability maintenance/improvement experienced by patients receiving home visits. Potential opportunities exist to integrate these insights into best-practice models of nurse home visiting.

Primary study

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A dementia care management intervention: which components improve quality?

Journal The American journal of managed care
Year 2012
Links Pubmed

This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVES: To analyze whether types of providers and frequency of encounters are associated with higher quality of care within a coordinated dementia care management (CM) program for patients and caregivers. DESIGN: Secondary analysis of intervention-arm data from a dementia CM cluster-randomized trial, where intervention participants interacted with healthcare organization care managers (HOCMs), community agency care managers (CACMs), and/ or healthcare organization primary care providers (HOPCPs) over 18 months. METHODS: Encounters of 238 patient/caregivers (dyads) with HOCMs, CACMs, and HOPCPs were abstracted from care management electronic records. The quality domains of assessment, treatment, education/support, and safety were measured from medical record abstractions and caregiver surveys. Mean percentages of met quality indicators associated with exposures to each provider type and frequency were analyzed using multivariable regression, adjusting for participant characteristics and baseline quality. RESULTS: As anticipated, for all 4 domains, the mean percentage of met dementia quality indicators was 15.5 to 47.2 percentage points higher for dyads with HOCM--only exposure than for dyads with none (all P < .008); not anticipated were higher mean percentages with increasing combinations of provider-type exposure-up to 73.7 percentage points higher for safety (95% confidence interval 65.2%-82.1%) with exposure to all 3 provider types compared with no exposure. While greater frequency of HOCM-dyad encounters was associated with higher quality (P < .04), this was not so for other provider types. CONCLUSIONS: HOCMs' interactions with dyads was essential for dementia care quality improvement. Additional coordinated interactions with primary care and community agency staff yielded even higher quality.

Primary study

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Dementia management programme in a community setting and the use of psychotropic drugs in the elderly population.

Journal Scandinavian journal of primary health care
Year 2011
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND AND OBJECTIVE: The number of elderly persons in society is increasing, placing additional demands on the public health system. Extensive use of drugs is common in the elderly, and in patients with dementia this further increases their vulnerability. Since 1998 the municipality of Kalmar, Sweden, has worked with a dementia management programme that focuses on early intervention in order to identify the patient's help needs at an early stage. An important part of the programme aims at optimizing pharmacological treatment. The objective of the present study is to evaluate whether the dementia programme had a secondary effect on the use of psychotropic medication in the elderly population in general. DESIGN AND SETTING: A retrospective, drug utilization study analysing the use of selected drug categories by the elderly (75 years and older) in the Kalmar municipality compared with the whole of Sweden. RESULTS AND CONCLUSIONS: The results suggest that the dementia programme contributed to an improvement in psychotropic drug use in the elderly as a secondary effect. Furthermore, the implementation of this programme did not require allocation of extra funding.

Publication Thread

Judge KS et al [2011]

This thread includes 4 references

Primary study

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Randomized controlled trial of a dementia care programme for families of home-resided older people with dementia.

Authors Chien WT , Lee IY
Journal Journal of advanced nursing
Year 2011
Links Pubmed DOI

This article is included in 8 Systematic reviews Systematic reviews (8 references)

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AIM: This paper reports a study to examine the effectiveness of a 6-month dementia care programme for Chinese families living with and caring for a relative with dementia, compared with routine family support services in Hong Kong. BACKGROUND: Recognizing the adverse psychosocial health effects inherent in dementia care, different psychosocial interventions provided preliminary evidence of their effectiveness in improving family members' knowledge and skills in caregiving and delaying dementia sufferers' illness deterioration and institutionalization. Little is known about the effects of such interventions for family caregivers' psychosocial health conditions, particularly in non-Western populations. METHODS: A randomized controlled trial was conducted with 92 Chinese families of a relative with dementia in two dementia care centres in Hong Kong. They were randomly selected from a dementia client list and then randomly assigned to receive either the dementia family care programme (n=46), or routine care only (n=46). Clients' symptoms and institutionalization, and caregivers' quality of life, burden and social support at recruitment, 1 week, and 12 and 18 months following intervention were measured and compared between the study groups using repeated measures MANOVAS followed by Helmert's contrast tests. Data was collected over a period of 24 months, between September 2007 and August 2009. RESULTS: Results of the MANOVAS and contrast tests indicated that at 18-month follow-up, participants in the family programme reported significantly greater improvements in clients' symptoms and institutionalization rates, and caregivers' quality of life and burden, when compared with their counterparts in the routine care group. CONCLUSION: These findings provide evidence that the dementia care family programme can improve the psychosocial functioning of both clients with dementia and their family caregivers in a Chinese population. Further research is recommended to investigate whether this intervention can also apply to families with different socio-economic backgrounds and across cultures.

Primary study

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Modernizing mental health services for older people: a case study.

Authors McCrae N , Banerjee S
Journal International psychogeriatrics / IPA
Year 2011
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: This paper describes an evaluation of a redevelopment program in a mental health service for older people, stimulated by U.K. Department of Health policy. IQCOL (Improving Quality of Care for Older People in Lambeth) was a two-year program to modernize and expand an inner-city service, with objectives to improve access, embed new functions, and tune the service towards the needs of the local community. The program evaluation aimed to contribute to knowledge on service planning and methodology for evaluating complex interventions. METHODS: The study evaluated the progress and outcomes of this multifaceted program. The realist model of evaluation was followed, with a dual emphasis on utility and generalizability. With an iterative approach, the pragmatic, longitudinal design comprised a combination of qualitative and quantitative methods to explain the process of change and to measure achievement of objectives. RESULTS: A high level of participation in evaluation activities was achieved. The workforce generally responded well to the program. However, progress in one team was hindered by understaffing and resistance to change, emphasizing that while localized provision may be desirable, team viability requires adequate resources and professional support. Improved access was indicated by a 13% increase of referrals. Data suggested earlier referral of dementia cases. Carer support was implemented, but assertive outreach was impeded by professional boundary issues. Ethnicity data showed that the service was responding to demographic trends. Positive views towards the program were associated with team resources and recent professional training. CONCLUSIONS: This case study demonstrates how whole system change can be achieved if sufficient attention is given to the needs of staff implementing the program. The evaluation emphasizes the importance of context in producing generalizable evidence on service development, and contributes useful methodological insights.

Publication Thread

Jansen et al

This thread includes 3 references

Primary study

Unclassified

Supporting family carers of community-dwelling elder with cognitive decline: a randomized controlled trial.

Journal International journal of family medicine
Year 2010
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis Broad syntheses (1 reference) 4 Systematic reviews Systematic reviews (4 references)

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Objective. Caring for a patient with cognitive decline has an important impact on the general well-being of family caregivers. Although highly appreciated, interventions in dementia home care remain mainly ineffective in terms of well-being. Consequently, in spite of an extensive support system, abrupt ending of home care remains more rule than exception. Method. The hypothesis was that the intervention of a care counselor, coordinating care in quasi-unstructured way during one year, will alleviate caregivers' feelings of depression. The study population was composed of community-dwelling patients with cognitive decline. A care counselor was at the exclusive disposal of the intervention group. Primary outcome measure was caregiver depression. Results. Finally, depression was 6.25 times less frequent in the intervention group. The actual intervention appeared minimal with only ten applications for more support followed by only three interventions effectively carried out. Although caregivers felt burdened and depressed, formal support remained stable. On the other hand, the availability of the care counselor made caregivers feel less depressed with the same amount of support. Conclusion. Carers do not always need to be surrounded with more professionals, but they want to feel more supported. In terms of policy, this could have some important implications.