Huei-Ling Huang

Family caregivers' role implementation at different stages of dementia.

Purpose The purpose of this study was to explore family caregivers’ role-implementation experiences at different stages of dementia. Patients and methods For this cross-sectional, exploratory study, 176 dyads of family caregivers and their community-dwelling elderly relatives with dementia were recruited from the neurological clinics of a medical center in Taiwan. The Family Caregiving Inventory was used to assess family caregivers for caregiving activities, role strain, role preparation, and help from others at different stages of care receivers’ dementia. Results Family caregivers’ caregiving activities were related to patients’ stages of dementia. For patients with mild dementia, caregivers provided more assistance in transportation and housekeeping. In addition to these two activities, family caregivers of patients with moderate dementia provided more assistance with mobility and protection. For patients with severe dementia, family caregivers provided more assistance with personal care, mobility and protection, transportation, and housekeeping. Overall, family caregivers reported having some preparation to provide care; the most difficult caregiving activity was identified as managing behavioral problems. Conclusion This study’s results provide a knowledge base for designing dementia stage-specific interventions in clinical practice and developing community-based, long-term care systems for families of patients with dementia.

Factors associated with dementia care practices among community health nurses: Results of a postal survey

BACKGROUND The incremental prevalence of dementia is making dementia management a worldwide issue. The role of community health nurses must grow along with the increasing aging population and the resulting increase in dementia cases. OBJECTIVES Explore the factors related to dementia care practices among the different types of community health nurses in Taiwan. DESIGN Cross-sectional study. SETTING Primary care centers or institutions in New Taipei City. PARTICIPANTS Community health nurses who work in health care centers (district nurses), long-term care centers (care managers), or home care institutions (home health care nurses). METHODS Self-completion questionnaires sent by mail. RESULTS A total of 195 participants returned the questionnaires (response rate 81.9%). Although 65.8% of participants had experience in case finding, just 34.6% of them reported using validated cognitive testing tools. Only 15% of participants provided case management following dementia case findings. The regression models showed that the different types of community health nurses, number of years working as a nurse, and their level of confidence was significantly related to their dementia care practice. District nurses identified significantly less suspected dementia cases and provided less nursing care to caregivers of dementia patients than care managers and home health care nurses. Among community health nurses, the care managers most often used formal cognitive instruments. District nurses provided the least amount of supportive resources information, had the most negative attitude and the lowest level of confidence toward dementia care than care managers and home health care nurses. CONCLUSIONS This study presented the profiles of dementia care practice in Taiwan. It showed the considerable variation in knowledge, attitude, confidence and dementia care practices among the different community health nurses. The professional roles regarding dementia care in Taiwan remain blurred. Future training must focus on promoting the level of confidence of community health nurses to identify and manage people with dementia and raise awareness about demented persons and their caregivers need. The priority of the policy on dementia care in the community must be raised to high, and the professional responsibilities and roles of the different types of community health nurses for the ever increasing dementia population in Taiwan must be redefined and optimized.

Psychometric Properties of the Finding a Balance Scale for Family Caregivers of Elders with Dementia in Taiwan

The Finding a Balance Scale, designed to measure the degree to which caregivers can balance the competing demands of caregiving and other priorities, assists health care providers in understanding the process of family caregiving. The aim of this study was to examine the scales psychometric properties and determine an appropriate cutoff score for identifying caregivers at high risk for poor caregiving consequences. We found adequate reliabilities and appropriate validities in a convenience sample of 197 family caregivers of elders with dementia in Taiwan. The optimal cutoff was also determined. The validated Finding a Balance Scale provides an assessment tool to explore the competing responsibilities, conditions, and difficulties for family caregivers of elders with dementia in Taiwan.

Agitated behaviors among elderly people with dementia living in their home in Taiwan

Background/aims Limited research has been conducted on agitated behavior in Taiwan and dementia among community-dwelling elderly. Therefore, this study focused on community elderly with dementia and a factor analysis of an inventory of their agitated behaviors was conducted. Patients and methods Participants (N=221) completed the Chinese Cohen-Mansfield Agitation Inventory, community form. Item analysis and exploratory factor analysis assessed reliability, validity, and the underlying factor structure. Results Five factors were extracted and accounted for 44.53% of the total variance. This study classified agitated behaviors into 5 main subtypes: physically agitated behaviors, destructive behaviors, verbally agitated behaviors, handling things behavior, and aggressive behaviors. Conclusion The results indicate that differences in the agitated behavior of elderly with dementia exist with respect to cultural background and setting. This novel research and its findings serve as a reference for assessing the agitated behaviors of elderly with dementia living in their homes. Applications may exist for other countries with Chinese/Taiwanese populations.

HOME-BASED CAREGIVER TRAINING: BENEFITS DIFFER BY CARE RECEIVERS' DEMENTIA DIAGNOSIS

longitudinal, prospective study has examined fall-related injuries in community dwelling older adults with dementia, but no studies have prospectively tracked in people with early memory problems. The purpose of this study was to describe the profile of fall events in people with early memory problems. Fifty-nine community dwelling Rural and Remote Memory Clinic (Saskatoon, Saskatchewan Canada) patients were followed prospectively for six months (x age 1⁄4 72, SD1⁄410.0, 55.9% female). Patient caregivers completed amonthly fall diary and a research assistant telephoned the caregiver every two weeks to increase accuracy of the collected data and to increase adherence. Over the six months, 35.6% of participants experienced a fall 10 participants (16.9%) experienced one fall and 11 participants (18.5%) experienced multiple falls. Over half of the falls (53.8%) occurred in the afternoon or evening, and 41.7% of participants were barefoot or were wearing socks/nylons at the time of the fall. The reason for the fall included trips (20%), slips (30%), loss of balance (36.7%) and not paying attention (13.3%). Activities at the time of the fall included position transitions (e.g., getting in/out of bed, chair, car or getting on/off toilet (45.8%), walking (20.8%), and climbing or descending steps, curbs or stairs (33.3%). The large majority of falls during walking or stair/step/curb negotiation occurred outdoors (84.6%) versus inside the home (15.4%). Very few injuries were reported fracture (n1⁄42), head impact (n1⁄41), bruises (n1⁄45) and cuts/scrapes (n1⁄43). Falls in people with early memory problems occurred primarily during position transitions or negotiating stairs/steps/ curb negotiation outdoors. The findings have implications for patient and caregiver training and environmental safety in the home and communities to target fall risk.

A home-based training program for family caregivers decreases their risk for depression

and life satisfaction both showed significant effects of time (ps < 0.05). In general, the caregivers reported declines in depressive symptoms and increasing life satisfaction overtime. Conclusions: We found support for improvements in the mental and emotional health of caregivers of dementia patients. The death of their loved one undoubtedly resulted in a period of loss and grief, yet it is possible the ensuing lifestyle offers increased wellbeing without caregiving responsibilities. Further implications for this research will be considered.