Early Start of Anti-Dementia Medication Delays Transition to 24-Hour Care in Alzheimer’s Disease Patients: A Finnish Nationwide Cohort Study

2021 ◽  
pp. 1-13
Author(s):  
Olli Halminen ◽  
Aino Vesikansa ◽  
Juha Mehtälä ◽  
Iiris Hörhammer ◽  
Teija Mikkola ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Home Care ◽  
Care Facility ◽  
Intensity Level ◽  
Early Start ◽  
Health And Social Care ◽  
Professional Home ◽  
Professional Home Care ◽  
At Home

Background: Dementia is one of the strongest predictors of admission to a 24-hour care facility among older people, and 24-hour care is the major cost of Alzheimer’s disease (AD). Objective: The aim of this study was to evaluate the association of early start of anti-dementia medication and other predisposing factors with 2-year risk of transition to 24-hour care in the nationwide cohort of Finnish AD patients. Methods: This was a retrospective, non-interventional study based on individual-level data from Finnish national health and social care registers. The incident cohort included 7,454 AD patients (ICD-10, G30) comprised of two subgroups: those living unassisted at home (n = 5,002), and those receiving professional home care (n = 2,452). The primary outcome was admission to a 24-hour care facility. Exploratory variables were early versus late anti-dementia medication start, sociodemographic variables, care intensity level, and comorbidities. Results: Early anti-dementia medication reduced the risk of admission to 24-hour care both in patients living unassisted at home, with a hazard ratio (HR) of 0.58 (p <  0.001), and those receiving professional home care (HR, 0.84; p = 0.039). Being unmarried (HR, 1.69; p <  0.001), having an informal caregiver (HR, 1.69; p = 0.003), or having a diagnosis of additional neurological disorder (HR, 1.68; p = 0.006) or hip fracture (HR, 1.61; p = 0.004) were associated with higher risk of admission to 24-hour care in patients living unassisted at home. Conclusion: To support living at home, early start of anti-dementia medication should be a high priority in newly diagnosed AD patients.

scholarly journals "Sidelined": Family Caregiver's Experience of the  Emergency Department: Insights from Family Caregivers of People with Alzheimer's Disease

2021 ◽  
Author(s):  
◽  
Sandra Roberta Ridley
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Lived Experience ◽  
Family Caregivers ◽  
Healthcare Professionals ◽  
Care Facility ◽  
Structured Interviews ◽  
Presenting Symptoms ◽  
Information Giving ◽  
Inpatient Settings

<p>Older patients with a cognitive deficit, such as seen in Alzheimer's Disease (AD), have not been extensively researched in ED. Often patients with AD are accompanied by a familiar person such as a family caregiver when they present to an acute care facility. Literature has shown that family caregivers' have reported dissatisfaction with interaction with healthcare professionals in inpatient settings. There is a paucity of research on the experiences family caregivers have in ED. This study explored the experiences of family caregivers of people with Alzheimer's Disease in the ED of a regional hospital in New Zealand. A Hermeneutic phenomenology method was used to bring meaning to the lived experience of family caregivers in the ED. Ricouers Interpretation theory was used to analyse and interpret the data. Six family caregivers were interviewed, using semi-structured interviews, to explore and give meaning to their experience. Findings revealed family caregivers were 'sidelined'; felt invisible, ignored and abandoned by the healthcare professionals in ED. There appeared to be little understanding about dementia symptoms, or the needs of caregivers of people with AD. The experience was distressing for participants who felt they were not able to relay information about their loved one that was pertinent to their health and presenting symptoms. Health Professionals tended to speak directly to their loved ones and not with the participants. Consequently there was a risk of misinformation and poor communication driving treatment decisions for these patients. Participants reported poor information giving and family caregivers were left for long periods of time with no contact, and no support. Despite this, caregivers justified and excused the actions of healthcare professionals. They became passive recipients of process and procedures that were not adequately explained.</p>

scholarly journals Ethnographic reflections on selfhood, embodiment and Alzheimer's disease

2004 ◽  
Vol 24 (6) ◽  
pp. 829-849 ◽  
Author(s):  
PIA C. KONTOS
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Care Facility ◽  
Ethnographic Study ◽  
The Body ◽  
Philosophical Tradition ◽  
Cultural Significance ◽  
Term Care ◽  
Long Term Care Facility ◽  
The World

Explicit in the current construction of Alzheimer's disease is the assumption that memory impairment caused by cognitive deficiencies leads to a steady loss of selfhood. The insistence that selfhood is the exclusive privilege of the sphere of cognition has its origins in the modern western philosophical tradition that separates mind from body, and positions the former as superior to the latter. This dichotomy suggests a fundamental passivity of the body, since it is primarily cognition that is held to be essential to selfhood. In contrast to the assumed erasure of selfhood in Alzheimer's disease, and challenging the philosophical underpinnings of this assumption, this paper presents the findings of an ethnographic study of selfhood in Alzheimer's disease in a Canadian long-term care facility. It argues and demonstrates that selfhood persists even with severe dementia, because it is an embodied dimension of human existence. Using a framework of embodiment that integrates the perspectives of Merleau-Ponty and Bourdieu, it is argued that selfhood is characterised by an observable coherence and capacity for improvisation, and sustained at a pre-reflective level by the primordial and socio-cultural significance of the body. The participants in this study interacted meaningfully with the world through their embodied way of ‘being-in-the-world’.

Who are the beneficiaries and what are the reasons for non-utilization of respite care? A cross-sectional study on family caregivers

2020 ◽  
Author(s):  
Jianan Huang ◽  
Nadja Münzel ◽  
Anke Scheel-Sailer ◽  
Armin Gemperli
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Home Care ◽  
Family Caregivers ◽  
Respite Care ◽  
Cross Sectional ◽  
Care Services ◽  
Cord Injury ◽  
Professional Home ◽  
Professional Home Care

Abstract BackgroundFamily caregivers assume substantial caregiving responsibilities for persons with chronic conditions, which leads to negative impact on their lives. Respite care is provided as a temporary relief for them. The design of appropriate respite care programs requires the identification of beneficiary subgroups for different types of services. The objectives of the study were to quantify the uptake of respite care services by family caregivers of persons with spinal cord injury, and to identify the main beneficiaries of the respective offers and the reasons for non-use.MethodsA cross-sectional survey of family caregivers of persons with spinal cord injury was conducted nationwide in Switzerland. The use of 11 different respite care services during the last 12 months was investigated, along with caregivers’ reasons for not using any respite service. Classification trees were used to characterize the beneficiaries and reasons for not using respite services.ResultsOne-third of family caregivers used at least one type of respite care service during the last 12 months. Utilization of respite care was found to be greater among those who employed professional home care (57% vs 24% among those without professional home care). There were marked cantonal differences in the utilization of respite care. The primary reason for not using respite services was “no demand” (80% among non-users of respite services), mainly among caregivers who were less emotionally affected by their caregiving tasks. Conclusions Utilization of respite care services primarily depends on living arrangements and place of residency and less on the functional status of the care recipient. Programs should thus be tailored to the cultural context of their potential users. This is best achieved through coordination with local health care professionals who can identify the needs, provide information, initiate referrals, and integrate the care into a larger support plan.

scholarly journals Formal home care use by older adults: trajectories and determinants in the Lc65+ cohort

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Julien Dupraz ◽  
Yves Henchoz ◽  
Brigitte Santos-Eggimann
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Home Care Services ◽  
Community Dwelling ◽  
Care Utilization ◽  
Financial Situation ◽  
Care Services ◽  
Major Interest ◽  
Professional Home ◽  
Professional Home Care

Abstract Background Given the increasing importance of formal home care services in policies dedicated to elder care, there is major interest in studying individuals’ characteristics determining their utilization. The main objective of this research was to quantify, during a 6-year timeframe, home care use trajectories followed by community-dwelling participants in a cohort study of older adults. The secondary objective was to identify factors associated with home care utilization using Andersen’s Behavioural Model of Health Services Use. Methods We proceeded to an analysis of data prospectively collected in the setting of the Lc65+ population-based study conducted in Lausanne (Switzerland). Self-reported utilization of professional home care in 2012 and 2018 was used to define trajectories during this timeframe (i.e. non-users, new users, former users and continuing users). Bivariable analyses were performed to compare new users to non-users regarding the three dimensions of Andersen’s model (predisposing, enabling and need factors) measured at baseline. Then, binomial logistic regression was used in a series of two hierarchical models to adjust for need factors first, before adding predisposing and enabling factors in a second model. Results Of 2155 participants aged between 69 and 78 in 2012, 82.8% remained non-users in 2018, whereas 11.2% started to use professional home care. There were 3.3% of continuing users and 2.7% of former users. New users exhibited a higher burden of physical and psychological complaints, chronic health conditions and functional limitations at baseline. After adjusting for these need factors, odds of home care utilization were higher only in participants reporting a difficult financial situation (OR 1.65, 95% CI 1.12–2.45). Conclusions In the setting of a Swiss city, incident utilization of formal home care by older adults appeared to be largely determined by need factors. Modifiable factors like personal beliefs and knowledge about home care services did not play a role. After adjusting for need, odds of becoming home care user remained higher in participants reporting a difficult financial situation, suggesting such vulnerability does not hamper access to professional home care in this specific context.

P2-399: RAMCIP PROJECT, A ROBOTIC ASSISTANT TO SUPPORT ALZHEIMER'S DISEASE PATIENTS AT HOME: A NOVEL APPROACH IN CAREGIVING

2016 ◽  
Vol 12 ◽  
pp. P798-P798
Author(s):  
Carla Abdelnour ◽  
Natalia Tantinya ◽  
Joan Hernandez ◽  
Elvira Martin ◽  
Silvia Garcia ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Novel Approach ◽  
Robotic Assistant ◽  
At Home

Predictors of Place of Death for Seniors in Ontario: A Population-Based Cohort Analysis

2006 ◽  
Vol 25 (4) ◽  
pp. 363-371 ◽  
Author(s):  
Sanober S. Motiwala ◽  
Ruth Croxford ◽  
Denise N. Guerriere ◽  
Peter C. Coyte
Keyword(s):  
Home Care ◽  
Economic Status ◽  
Cohort Analysis ◽  
Care Facility ◽  
Multinomial Logit Model ◽  
Population Based ◽  
Place Of Death ◽  
Fiscal Year ◽  
Term Care ◽  
At Home

ABSTRACTPlace of death was determined for all 58,689 seniors (age ≥ 66 years) in Ontario who died during fiscal year 2001/2002. The relationship of place of death to medical and socio-demographic characteristics was examined using a multinomial logit model. Half (49.2%) of these individuals died in hospital, 30.5 per cent died in a long-term care facility, 9.6 per cent died at home while receiving home care, and 10.7 per cent died at home without home care. Co-morbidities were the strongest predictors of place of death (p< 0.0001). A cancer diagnosis increased the chances of death at home while receiving home care; seniors with dementia were most likely to die in LTC facilities; and those with major acute conditions were most likely to die in hospitals. Higher socio-economic status was associated with greater probability of dying at home but contributed little to the model. Appropriate planning and resource allocation may help move place of death from hospitals to nursing homes or the community, in accordance with individual preferences.

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