Shannon Freeman

Predictors of caregiver distress among palliative home care clients in Ontario: evidence based on the interRAI Palliative Care.

OBJECTIVE This study examines predictors of caregiver distress among community-based palliative care clients. Analyses are based upon interRAI Palliative Care (interRAI PC) assessment data from palliative home care programs in three regions in Ontario, Canada. METHOD The study sample involved all community-based palliative care clients in Ontario who were assessed with the interRAI PC as part of normal clinical practice during pilot implementation of the instrument between 2007 and 2009 (N = 3,929). The assessments were performed by trained case managers and were used as the basis for determining service needs to be addressed through services contracted from provider agencies. The main study outcome of interest was the presence of one or more indicators of caregiver distress: helper(s) unable to continue caring activities; primary informal helper expresses feelings of distress, anger, or depression; family or close friends report feeling overwhelmed by persons illness. RESULTS Caregiver distress was evident among about 22% of palliative home care clients. Multivariate analyses identified included clinical instability (Changes in Health, End Stage disease, Signs and Symptoms [CHESS] scale), depressive symptoms, cognitive impairment, and positive outlook as significant client-level predictors. Significant caregiver characteristics included hours of informal care. Three service use/provider variables were significant predictors of caregiver distress: the specific home care agency, hospitalizations in the last 90 days, and nursing visits. SIGNIFICANCE OF RESULTS Caregiver distress affects approximately one in five palliative care clients in the community. This may lead to a number of adverse outcomes for the caregiver and client. The experience of distress is affected by client, caregiver, and agency characteristics that are readily identified by the interRAI PC assessment instrument. The present results point to the need for a care planning protocol that may be used on a targeted basis for clients experiencing or at elevated risk of caregiver distress.

Fall Prevention Using Olfactory Stimulation with Lavender Odor in Elderly Nursing Home Residents: A Randomized Controlled Trial

To investigate the effects of lavender olfactory stimulation intervention on fall incidence in elderly nursing home residents.

Understanding the oldest old in northern Japan: An overview of the functional ability and characteristics of centenarians

Aim:  To increase knowledge of the functional ability of centenarians by examining the situation of Japanese centenarians residing in an urban region in northern Japan.

Caregiving burden for the oldest old: A population based study of centenarian caregivers in Northern Japan

This study investigated caregiving burden of the oldest old specifically focusing on caregivers of centenarians and aimed to determine if caregivers of centenarians in Japan can be considered models for successful caregivers. Data was collected from 160 people aged 80-107 and 84 of their caregivers aged 24-92 using a self-reported questionnaire survey. Caregivers of centenarians do not exhibit significantly less burden, less prevalence of depression, or higher quality of life than caregivers of 80-99 year olds. Burdened caregivers experienced poorer general health (GH), more bodily pain (BP), less vitality (VT), difficulties with social functioning (SF), and poorer mental health (MH) than less burdened caregivers. While all caregivers scored below expected Japanese average scores for Health-related quality of life short form-36 (HRQoL SF-36), those reporting utilization of private care services, providing care regularly, and providing care for more than 5h per day exhibited the lowest scores. Caregivers of centenarians may not represent models of successful caregivers. Caregivers showed equal distribution of light and heavy burden among recipient age groups therefore it may be inferred that as care recipient age increases it is not inevitable that they become heavier burdens on their caregivers. This is the first in-depth study to investigate the unique situation of centenarians and their caregivers in Northern Japan.

Prevalence and risk factors of depressive symptoms in a Canadian palliative home care population: a cross-sectional study

BackgroundDepression in palliative care patients is important because of its intrinsic burden and association with elevated physical symptoms, reduced immunity and increased mortality risk. Identifying risk factors associated with depression can enable clinicians to more readily diagnose it, which is important since depression is treatable. The purpose of this cross-sectional study was to determine the prevalence of depressive symptoms and risk factors associated with them in a large sample of palliative home care patients.MethodsThe data come from interRAI Palliative Care assessments completed between 2006 and 2012. The sample (n = 5144) consists of adults residing in Ontario (Canada), receiving home care services, classified as palliative, and not experiencing significant cognitive impairment. Logistic regression identified the risk factors associated with depressive symptoms. The dependent variable was the Depression Rating Scale (DRS) and the independent variables were functional indicators from the interRAI assessment and other variables identified in the literature. We examined the results of the complete case and multiple imputation analyses, and found them to be similar.ResultsThe prevalence of depressive symptoms was 9.8%. The risk factors associated with depressive symptoms were (pooled estimates, multiple imputation): low life satisfaction (OR = 3.01 [CI = 2.37-3.82]), severe and moderate sleep disorders (2.56 [2.05-3.19] and 1.56 [1.18-2.06]), health instability (2.12 [1.42-3.18]), caregiver distress 2.01 [1.62-2.51]), daily pain (1.73 [1.35-2.22]), cognitive impairment (1.45 [1.13-1.87]), being female (1.37 [1.11-1.68]), and gastrointestinal symptoms (1.27 [1.03-1.55]). Life satisfaction mediated the effect of prognostic awareness on depressive symptoms.ConclusionsThe prevalence of depressive symptoms in our study was close to the median of 10-20% reported in the palliative care literature, suggesting they are present but by no means inevitable in palliative patients. Most of the factors associated with depressive symptoms in our study are amenable to clinical intervention and often targeted in palliative care programs. Designing interventions to address them can be challenging, however, requiring careful attention to patient preferences, the spectrum of comorbid conditions they face, and their social supports. Life satisfaction was one of the strongest factors associated with depressive symptoms in our study, and is likely to be among the most challenging to address.

“When the Golden Years Are Blue”: Changes in Depressive Symptoms Over Time Among Older Adults Newly Admitted to Long-Term Care Facilities

This study investigated the prevalence of depressive symptoms and diagnoses among older adults newly admitted to long-term care facilities (LTCFs) in Ontario, Canada. Using anonymous cross-sectional and longitudinal Minimum Data Set 2.0 (MDS 2.0) assessments (N = 63,095), changes in depressive symptoms and predictors of depression following admission to institutional care were examined. Depressive symptoms were present in 54.3 cases per 100 residents at initial assessment, increasing to 60.8 cases per 100 residents by follow-up. Although depressive symptoms worsened, approximately 30% of residents showed moderate to significant improvement following LTCF admission. Results are discussed in the context of the MDS 2.0 and interRAI Mood CAP as a resource for LTCF care staff.

Breaking Down Barriers: Hospice Palliative Care as a Human Right in Canada

The need to attend to terminally ill persons and provide improved quality of living and dying should be a national priority in Canada. Hospice palliative care (HPC), a person-centered approach that addresses the needs of the whole person, improves the quality of living and dying of persons facing a life-threatening illness. To ensure Canadians are able to benefit from HPC, we propose that it should be enshrined as a human right in Canada with access guaranteed to all terminally ill persons under the Canada Health Act (CHA). This paper describes numerous barriers that currently exist including, but not limited to, barriers from geographic location, prognosis, ageism, and constraints from the Canadian medical system that have resulted in unequal access to of a patchwork of services. This paper proposes if HPC is formally recognized as a human right, then financial allocation specifically for HPC will require provincial governments to address the substantial inequalities in access to HPC.

Cough reflex and oral chemesthesis induced by capsaicin and capsiate in healthy never-smokers

BackgroundMany tussive agents are components of foods, but little is known about the relationship between cough reflex and oral chemesthesis sensitivities. We investigated the relationships between cough reflex and oral chemesthesis in individuals using two transient receptor potential vanilloid 1 (TRPV1) agonists with different potencies: capsaicin and capsiate.MethodsTwenty-eight healthy never-smokers were allocated to evaluate cough and oral chemesthesis of capsinoids. Cough reflex sensitivities are estimated by the lowest concentrations generating five coughs by each TRPV1 agonist inhalation. Oral chemesthesis sensitivities are estimated by the lowest concentrations which generate a hot sensation when filter paper loaded with each TRPV1 agonist is placed on the tongue.ResultsThere were strong correlations between capsaicin- and capsiate-induced cough reflex sensitivities, and between capsaicin- and capsiate-induced oral chemesthesis sensitivities. However, there were no significant correlations between cough reflex and oral chemesthesis sensitivities induced by both capsaicin and capsiate. The cough reflex sensitivities are significantly greater in females than in males whereas there were no gender differences in oral chemesthesis.ConclusionThe results showed that the sensitivities of sensory afferents were different between cough reflex and oral chemesthesis, suggesting that TRPV1 sensitivities differ between organs within healthy individuals. Capsiate could be a tussigen for the cough challenge test.

A Scoping Review of Digital Gaming Research Involving Older Adults Aged 85 and Older

BACKGROUND Interest in the use of digital game technologies by older adults is growing across disciplines from health and gerontology to computer science and game studies. The objective of this scoping review was to examine research evidence involving the oldest old (persons 85 years of age or greater) and digital game technology. MATERIALS AND METHODS PubMed, CINHAL, and Scopus were searched, and 46 articles were included in this review. RESULTS Results highlighted that 60 percent of articles were published in gerontological journals, whereas only 8.7 percent were published in computer science journals. No studies focused directly on the oldest old population. Few studies included sample sizes greater than 100 participants. Seven primary and 34 secondary themes were identified, of which Hardware Technology and Assessment were the most common. CONCLUSIONS Existing evidence demonstrates the paucity of studies engaging older adults 85 years of age and above regarding the use of digital gaming and highlights a new understudied cohort for further research focus. Recommendations for future research include intentional recruitment and proportionate representation of participants ≥85 years of age, large sample sizes, and explicit mention of specific numbers of participants ≥85 years of age, which are necessary to advance knowledge in this area. Integrating a rigorous and robust mixed-methods approach including theoretical perspectives would lend itself to further in-depth understanding and knowledge generation in this field.

Patient Characteristics Associated With Prognostic Awareness: A Study of a Canadian Palliative Care Population Using the InterRAI Palliative Care Instrument

CONTEXT Awareness of their medical prognosis enables terminally ill patients to make decisions on treatments and end-of-life care/planning, and to reach acceptance. Yet, many patients receiving palliative care (PC) are unaware of their prognosis, even when death is imminent and has been discussed with health care providers. A better understanding of patient characteristics associated with prognostic awareness (PA) is needed to develop interventions aimed at improving it. OBJECTIVES To identify patient characteristics associated with PA in a PC population. METHODS The sample comprised 2090 palliative home care patients in Ontario, Canada, assessed using the interRAI Palliative Care Assessment. Independent variables included sociodemographic, cognitive/physical functioning, mood, psychological well-being, and social support. Using cross-sectional data, an adjusted logistic regression model was developed to identify key patient characteristics associated with PA. A multifaceted definition of PA was assumed and represented dichotomously in the model. Multiple imputation was used to address missing data, generating results similar to the complete case analysis. RESULTS The PA was higher in patients with: a shorter prognosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.93-4.33), increased hours of informal care (OR 1.71, 95% CI 1.15-2.52), less cognitive impairment (OR 1.61, 95% CI 1.14-2.28), and in patients at peace with life (OR 1.79, 95% CI 1.27-2.53). Site differences were observed but do not reflect differences in age, gender, prognosis, or diagnosis. CONCLUSION Some patient characteristics are amenable to clinical intervention to raise PA, such as being at peace, cognitive impairment, and depression. Prognostic communications vary in timing and quality and may underlie our site differences, but further research is required to confirm this.