scholarly journals Managing diabetes in people with dementia: a realist review

2017 ◽  
Vol 21 (75) ◽  
pp. 1-140 ◽  
Author(s):  
Frances Bunn ◽  
Claire Goodman ◽  
Peter Reece Jones ◽  
Bridget Russell ◽  
Daksha Trivedi ◽  
...  
Keyword(s):  
Older People ◽  
Intervention Strategy ◽  
Realist Review ◽  
Cochrane Library ◽  
Future Research ◽  
Care Providers ◽  
Long Term Conditions ◽  
People With Dementia ◽  
Increased Risk

BackgroundDementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes.ObjectivesTo identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research.DesignRealist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders.ParticipantsTwenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference.Data sourcesThe following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing – UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA).ResultsWe included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context–mechanism–outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia.LimitationsThere is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven.ConclusionsThis review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes.Study registrationThis study is registered as PROSPERO CRD42015020625.FundingThe NIHR HTA programme.

A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia

2016 ◽  
Vol 29 (1) ◽  
pp. 81-91 ◽  
Author(s):  
Morag E. Taylor ◽  
Stephen R. Lord ◽  
Henry Brodaty ◽  
Susan E. Kurrle ◽  
Sarah Hamilton ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older People ◽  
Exercise Program ◽  
Community Dwelling ◽  
Future Research ◽  
Exercise Interventions ◽  
People With Dementia ◽  
Home Based ◽  
Increased Risk ◽  
Community Dwelling Older People

ABSTRACTBackground:Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia.Methods:Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial.Results:Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to <70% of sessions.Conclusions:This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.

scholarly journals What matters to people with multiple long-term conditions and their carers?

2021 ◽  
pp. postgradmedj-2021-140825
Author(s):  
Gemma Spiers ◽  
Elisabeth Boulton ◽  
Lynne Corner ◽  
Dawn Craig ◽  
Stuart Parker ◽  
...  
Keyword(s):  
Older People ◽  
Public Involvement ◽  
Research Priorities ◽  
Well Being ◽  
Future Research ◽  
Long Term Conditions ◽  
Ongoing Research ◽  
Published Research ◽  
What Matters

BackgroundThe number of people living with multiple long-term conditions is increasing worldwide. This presents challenges for health and care systems, which must adapt to meet the needs of this population. This study drew on existing data to understand what matters to people living with multiple long-term conditions and identify priorities for future research.MethodsTwo studies were conducted. (1) A secondary thematic analysis of interview, survey and workshop data collected from the 2017 James Lind Alliance Priority Setting Partnership for Older People with Multiple Conditions, and patient and public involvement workshops; (2) a review of ongoing research and published research priorities, relating to older people (80+) living with multiple long-term conditions.FindingsOlder people with multiple long-term conditions identified a number of key concerns: access to care, support for both the patient and their carer, physical and mental health and well-being and identifying opportunities for early prevention. The review identified no published research priorities or ongoing research focusing specifically on populations aged over 80 years with multiple long-term conditions.ConclusionOlder people living with multiple long-term conditions experience care that is inadequate for their needs. A holistic approach to care that extends beyond treating single conditions will ensure wide-ranging needs are met. As multimorbidity rises worldwide, this is a critical message for practitioners across health and care settings. We also recommend key areas that should be given greater focus in future research and policy to inform effective and meaningful forms of support for people living with multiple long-term conditions.

Advance care planning for an ageing population

2018 ◽  
Author(s):  
Martin J. Vernon
Keyword(s):  
Older People ◽  
Advance Care Planning ◽  
Later Life ◽  
Ageing Population ◽  
Care Planning ◽  
Long Term Conditions ◽  
Health Decline ◽  
People With Dementia ◽  
Increased Risk ◽  
Advance Care

Population ageing is driven by declining fertility and improved life expectancy. As people survive to later life with multiple long-term conditions, advance care planning ACP) is of increasing importance to those wishing to retain control over their end-of-life care. Understanding disability trajectories for people can assist with advance care planning, mindful that older people living with frailty have increased risk of acute and unexpected health decline. Routine frailty identification by severity in older people can prompt care planning in anticipation of health decline and imminent lost capacity to make important decisions. Recognizing potential professional and organizational barriers to advance carer planning for older people could also improve its uptake. Guided serious illness conversations could assist this process over time for older people and those important to them. In care homes and among people with dementia ACP is also likely to be beneficial.

The use of a bespoke website developed for people with dementia and carers: Users’ experiences, perceptions and support needs

Dementia ◽  
2021 ◽  
pp. 147130122110284
Author(s):  
Emma Wolverson ◽  
Caroline White ◽  
Rosie Dunn ◽  
Katie Cunnah ◽  
David Howe ◽  
...  
Keyword(s):  
Personal Information ◽  
Information Source ◽  
Website Design ◽  
Long Term Conditions ◽  
People With Dementia ◽  
Barriers To Use ◽  
Credible Information ◽  
Training And Support ◽  
Design And Methods

Background: Current policy emphasises the role of digital technologies in facilitating the management of long-term conditions. While digital resources have been developed for carers, there has been little attention to their development for people with dementia. The Caregiverspro-MMD website was developed as a joint resource for people with dementia and carers, delivering access to information, informal content, games and peer support. Research Design and Methods: This study explored the experiences of dyads consisting of people with dementia and carers of using the website. Interviews and focus groups were conducted with 43 participants. Findings: Thematic analysis identified 10 subthemes grouped under three superordinate themes which highlight participants’ experiences of and responses to the website functions; important aspects of the website design and delivery; and barriers to use. Discussion: Findings highlight the value of a credible information source which negated the need for arduous online searches, the pleasure associated with playing games and interacting with others online. However, participants were reluctant to share personal information online, preferring to create ‘informal content’ which celebrated everyday life, and were reluctant to ‘friend’ people online who they had not met in person. The importance of training and support to use the website was highlighted. Health problems, lack of interest or difficulties using technology, and time were all identified as barriers to use.

Medication Management for Community-dwelling Older People with Dementia and Chronic Illness

2008 ◽  
Vol 14 (1) ◽  
pp. 25 ◽  
Author(s):  
Debbie Kralik ◽  
Kate Visentin ◽  
Geoff March ◽  
Barbara Anderson ◽  
Andrew Gilbert ◽  
...  
Keyword(s):  
Chronic Illness ◽  
Older People ◽  
Medication Management ◽  
Community Dwelling ◽  
Consumer Involvement ◽  
Future Research ◽  
Coordination Of Care ◽  
Health Providers ◽  
People With Dementia ◽  
Community Dwelling Older People

The purpose of this paper is to report the findings of an integrative review of the literature on medication management for individuals who live in the community and have both chronic illness and mild to moderate dementia. The aim of the review was to summarise what is known about this topic, evaluate and compare previous research on the topic of medication management for people with dementia, and locate gaps in current work, thus pointing to directions for future research. Dementia is a national health priority for Australia. A significant component of community care for people with dementia is the management and administration of the medications required for other chronic conditions. Medication management is a broad term that encompasses several aspects, such as client-centred medication review, rational prescribing and support, repeat prescribing, client information/education, capacity to communicate with multiple health providers and having access to medicines. Cognitive impairment has been associated with medication management issues so it is important to ensure quality outcomes of medicine use by community-dwelling older people with dementia. The literature revealed a number of issues, such as the importance of person-centred care, the need for the coordination of care, and consumer partnerships in medication management. These are all important considerations in planning primary care services to support people with dementia and chronic illnesses. People with dementia who have chronic illness require coordinated, tailored, and flexible care processes in the community. There exists a range of services and programs such as home medicine reviews to support people living in the community with chronic illness and dementia; however, there is little coordination of care and evaluation of interventions is, at best, inconsistent. Currently, Australia lacks an integrative primary health care (PHC) framework, within which consumer involvement in decision-making and/or care planning is valued and sought. Current services are limited in the degree to which there is collaboration between key partners and Australian PHC initiatives are fragmented and have limited impact on service delivery.

Comparative Study of Outcomes for Older People with Long Term Conditions Attending Day Care Services Delivered by Paid Staff or by Volunteers

2020 ◽  
Author(s):  
Catherine Lunt ◽  
Chris Shiels ◽  
Christopher Dowrick ◽  
Mari Lloyd-Williams
Keyword(s):  
Older People ◽  
Comparative Study ◽  
Day Care ◽  
Symptom Burden ◽  
Well Being ◽  
Long Term Conditions ◽  
North West ◽  
Age In Place ◽  
Care Services

Abstract Background Day care services can support older people living with multiple long term conditions (LTCs), to age in place, but little research on outcomes of Day Care attendance. Aims The aims of this comparative study were to determine outcomes for older people with LTCs attending day care services run entirely by paid staff or predominantly volunteers Methods Newly referred older people with LTCs to nine day care services in North West of England and North Wales were invited to participate in this longitudinal study with data being collected at baseline attendance and at 6 and 12 weeks. Demographic information was collected and the EQ-5D-3L and De Jong Loneliness 6 item questionnaire were completed at each time point.RESULTS 94 older people (64% female),age range 65 - 99 years (mean 82 years) were recruited. The mean number of LTCs was 4.3 (range 2-9) and 52% people lived alone. More than a third (36%) lived in one of the 20% most deprived local authorities in England and Wales. The outcomes in this exploratory study over 12 weeks appeared to be similar for paid, blended (paid staff and volunteers) and for volunteer led service, with those attending volunteer led services were significantly more likely to report fewer health problems in follow-up (OR=3.45, 95% CI 1.01-12.8, P=0.04). CONCLUSIONS This study suggests that Day Care Services for older people with long term conditions provide benefits in terms of self-rated physical and emotional well-being. Older people attending paid staff services were more likely to have greater number of LTCs associated with a higher symptom burden. However, at baseline there was no difference in self-reported health by service type. This study suggests that Day Care Services provided by volunteers can provide comparable outcomes. Following the Covid-19 pandemic, it is increasingly urgent to support older people with long term conditions who have lost physical and cognitive function during lockdown and to maintain and improve their function. Our study suggests that volunteers may be able to complement the care provided by paid staff freeing up resources and enabling increasing numbers of people to be supported.

Extending the Comfort Zone: Building Resilience in Older People With Long-Term Conditions

2017 ◽  
Vol 38 (6) ◽  
pp. 825-848 ◽  
Author(s):  
Mark Robinson ◽  
Esmée Hanna ◽  
Gary Raine ◽  
Steve Robertson
Keyword(s):  
Older People ◽  
Peer Support ◽  
Social Engagement ◽  
Well Being ◽  
Significant Drop ◽  
Long Term Conditions ◽  
Before And After ◽  
And Gender ◽  
Ongoing Support

This article examines how a 6-week mental health resilience course for people with long-term conditions (LTCs; diabetes, heart disease, and arthritis) increased perceived resilience of older participants. This article examines how peer support assisted participants to develop resilience, considers gender issues, examines the importance of course activities, and explores how resilience enhances quality of life. A mixed methods approach was used. A before-and-after questionnaire was administered 3 times, including 3-month follow-up. Interviews were held with 24 program participants, aged 45 to 80 years. Diaries were kept by participants over 3 months. Survey findings showed significant gains in perceived resilience, at the end of the course, with no significant drop-off after 3 months. Interview and diary narratives highlighted positive experiences around well-being, condition management, and social engagement. Peer support was key to effective processes. Challenges concern ongoing support in communities, and considering age and gender variables when researching what improved resilience means to older people with LTCs.

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