Faranak Aminzadeh

Dementia diagnosis disclosure : A study of patient and caregiver perspectives

This paper reports the findings of a descriptive, exploratory, qualitative study of patient and caregiver perspectives of the disclosure of a dementia diagnosis. Data were collected at 3 points in time: (1) the disclosure meeting, (2) patient and caregiver interviews, and (3) focus group interviews. Thirty patient-caregiver dyads participated in the disclosure meetings at the Geriatric Day Hospital at the Ottawa Hospital, Ottawa, Canada. Within a week of the disclosure of diagnosis, 27 (90%) patients and 29 (97%) caregivers were interviewed in their homes, and 12 caregivers participated in 3 focus group interviews within 1 month after the disclosure meeting. Most patients and caregivers said they preferred full disclosure of the diagnosis. Patients expressed satisfaction with the physician providing the diagnosis and with their caregivers being present at the disclosure meeting, however, wanted more information about their condition. Caregivers provided further insight regarding the patient response, and suggested the need to emphasize hope in the face of a difficult diagnosis, the use of progressive disclosure to allow the person (and caregivers) to prepare, and the provision of detail about the disease and its progression.

A Review of Barriers and Enablers to Diagnosis and Management of Persons with Dementia in Primary Care

Background With the rise in the prevalence of dementia disorders and the growing critical impact of dementia on health-care resources, the provision of dementia care has increasingly come under scrutiny, with primary care physicians (PCP) being at the centre of such attention. Purpose To critically examine barriers and enablers to timely diagnosis and optimal management of community living persons with dementia (PWD) in primary care. Methods An interpretive scoping review was used to synthesize and analyze an extensive body of heterogeneous Western literature published over the past decade. Results The current primary care systems in many Western countries, including Canada, face many challenges in providing responsive, comprehensive, safe, and cost-effective dementia care. This paper has identified a multitude of highly inter-related obstacles to optimal primary dementia care, including challenges related to: a) the complex biomedical, psychosocial, and ethical nature of the condition; b) the gaps in knowledge, skills, attitudes, and resources of PWD/caregivers and their primary care providers; and c) the broader systemic and structural barriers negatively affecting the context of dementia care. Conclusions Further progress will require a coordinated campaign and significantly increased levels of commitment and effort, which should be ideally orchestrated by national dementia strategies focusing on the barriers and enablers identified in this paper.

Symbolic meaning of relocation to a residential care facility for persons with dementia

Objectives: This study explored the perspectives of persons with dementia (PWD) on the meanings and experiences associated with relocation to a residential care facility (RCF). Methods: A qualitative design was employed, which involved in-depth interviews with 16 PWD at their homes within two months prior to relocation. The work of Strauss and Corbin guided the analysis process. Results: Participants viewed relocation to an RCF as a major residential change and life transition requiring significant adaptive efforts. The experience clearly had a profound personal meaning for the participating PWD, shaped by their unique personal identities, psycho-environmental histories and current living circumstances. However, despite individual variations, four major themes captured the common perspectives and experiences in the sample. Relocation to an RCF: (a) symbolized the end of an era and a long-established way of life; (b) signaled the inevitable downward trajectory of old age; (c) meant living a more protected, dependent, structured and communal lifestyle in a place that is associated with ‘hospitality’ and ‘rest’; and (d) presented a life course challenge that could be dealt with by drawing on ones sense of identity as a ‘survivor’. Conclusion: The findings raise awareness of the subjective meanings of residential transitions in the experience of aging with dementia, and inform supportive interventions to optimize housing decisions for PWD in order to promote successful adaptation to their new living environments.

Targeting frail older adults for outpatient comprehensive geriatric assessment and management services: An overview of concepts and criteria

Comprehensive geriatric assessment (CGA) has been defined as ‘a multidimensional, often interdisciplinary, diagnostic process intended to determine a frail elderly person’s medical, psychosocial, and functional capabilities and problems, with the objective of developing an overall plan for treatment and long-term follow-up’. Evidence from recent meta-analyses of clinical trials of the effectiveness of CGA programmes suggest that older persons may experience a variety of health benefits from these comprehensive services.

Continuing Education for Staff in Long-Term Care Facilities: Corporate Philosophies and Approaches.

The purpose of this study was to determine corporate philosophies of continuing education and approaches to meeting the learning needs of staff who strive to provide for the increasingly challenging care requirements of seniors who reside in long-term care facilities. In-depth interviews lasting approximately 1 hour were conducted with key informants at the administrative level from nine long-term care facilities. Content analysis revealed a commitment to continuing education for staff. While recognizing the importance of organizational responsibility for continuing education, administrators placed emphasis on the individual responsibility of staff. Learning needs were identified as affective, managerial, and physical in nature. Challenges to providing continuing education programs were derived from a general lack of fiscal and human resources. A variety of measures was suggested as important to supporting the continuing learning of staff. Implications of this study point to the need for long-term care facilities to incorporate into their strategic plans measures of ensuring continuing education as a basis for the ongoing competence and development of staff. In addition, there is a need for collaboration between long-term care facilities and other institutions of a long-term care, acute care, and educational nature in the development of strategies to operationalize a philosophy of continuing learning as a basis for the provision of optimal care to residents.

Effectiveness of outpatient geriatric assessment programs: exploring caregiver needs, goals, and outcomes.

In this study, the authors examined the goals and outcomes of 141 caregivers of older adults with cognitive impairment who attended a comprehensive geriatric assessment program (CGA). The vast majority of caregivers expressed at least one assessment goal, suggesting that the concept was relevant to them. Most caregiver goals focused on patient needs, with only 10% expressing goals specifically related to their own coping needs. At follow up, more than two-thirds of caregiver goals were attained. The findings confirm the great potential of CGA programs in promoting positive outcomes and point to the opportunities for nurses to improve the process of care.

Predictors of Bath Grab-Bar Use among Community-Living Older Adults

Bathrooms are a common location for falls among older adults. Bath grab bars can assist in promoting safe bath transfers. The aim of this study was to identify predictors of bathroom safety-device use among community-living seniors. A two-stage sampling strategy was used to select, first, a random sample of non-universal apartment buildings and a matched sample of universal buildings, from among non-profit apartment buildings in two Canadian regions; and second, a random sample of participants within each building. A total of 550 seniors participated in face-to-face interviews in their apartments. Participants within each building type presented with similar profiles. A logistic regression was used to identify predictors of grab-bar use among participants who had grab bars and entered the bathtub on a regular basis ( n = 478). Significant predictors, in order of odds ratios, were bathing difficulties, ease of grab-bar use, living in buildings with policies supporting universal access to grab bars, having a history of falls, and reporting few psychosocial consequences of grab-bar use. Findings of this study emphasize the importance of promoting access as a key strategy for increasing use and have important implications for policy planning and falls-prevention initiatives.

Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia.

BACKGROUND Disruptive behaviors are frequent and often the first predictor of institutionalization. The goal of this multi-center study was to explore the perceptions of family and staff members on the potential contribution of environmental factors that influence disruptive behaviors and quality of life of residents with dementia living in long-term care homes. METHODS Data were collected using 15 nominal focus groups with 45 family and 59 staff members from eight care units. Groups discussed and created lists of factors that could either reduce disruptive behaviors and facilitate quality of life or encourage disruptive behaviors and impede the quality of life of residents. Then each participant individually selected the nine most important facilitators and obstacles. Themes were identified from the lists of data and operational categories and definitions were developed for independent coding by four researchers. RESULTS Participants from both family and staff nominal focus groups highlighted facility, staffing, and resident factors to consider when creating optimal environments. Human environments were perceived to be more important than physical environments and flexibility was judged to be essential. Noise was identified as one of the most important factors influencing behavior and quality of life of residents. CONCLUSION Specialized physical design features can be useful for maintaining quality of life and reducing disruptive behaviors, but they are not sufficient. Although they can ease some of the anxieties and set the stage for social interactions, individuals who make up the human environment are just as important in promoting well-being among residents.

An Exploration of Adjustment Needs and Efforts of Persons with Dementia After Relocation to a Residential Care Facility

This study examined the adjustment needs and efforts of individuals with dementia after relocation to a residential care facility. This was a qualitative prospective study that involved in-depth face-to-face interviews with 16 individuals with dementia and their family caregivers at 2 and 6 months post-relocation. In their efforts to recreate a sense of home, individuals with dementia had to meet three major highly interrelated and overlapping categories of needs to settle in, fit in, and find meaning in this transition. The satisfactory fulfillment of these adjustment needs resulted in a sense of comfort, connection, and continuity associated with feeling at home. Participants’ efforts to place themselves in their new living environments created a simultaneous need to integrate relocation into their overall sense of self. The results support earlier research indicating that place making is a critical process in the overall psychosocial adjustment to old age. The findings inform supportive interventions to assist individuals with dementia to reconstruct home in a residential care environment.

Targeting at Risk Older Adults in Residential Care Facilities for Specialized Geriatric Services

Abstract This study involved multidimensional geriatric assessment of a representative sample of 178 older adults living in residential care facilities in the City of Ottawa, Canada. The main objective of this paper was to test the utility of two geriatric screening tools to identify appropriate candidates for specialized geriatric services: Geriatric Status Scale (GSS) and Probability of Repeated Hospital Admissions (Pra). Both scales showed limited criterion validity as screening tools for the selection of appropriate candidates for specialized geriatric services. However, a modified GSS target range improved the scales performance considerably and it emerged as one of the four statistically significant predictors of a referral to these services in the multivariate analyses.