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Is there agreement between Canadian older adults and their primary informal caregivers on behaviour towards institutionalisation?
- Authors:
- DUBOIS Marie-France, et al
- Journal article citation:
- Health and Social Care in the Community, 16(6), November 2009, pp.610-618.
- Publisher:
- Wiley
Behaviour towards institutionalisation between frail older adults and their informal caregivers, and identify correlates of differential behaviour. Five hundred and ninety three participants and their primary informal caregivers involved in a longitudinal study following older adults identified at risk of functional decline, were asked separately if they thought about institutionalisation placement, discussed it with someone or visited an institution during the previous year. Compared with neither person thinking about it, the care-receiver alone thinking about placement was associated with using voluntary services, receiving help for home maintenance and visits to the emergency room during the previous year, along with the caregiver being aged 70 years or over. Compared with neither person thinking about it, the caregiver alone thinking about placement was associated with being male, not residing with the care-receiver, sensing a higher subjective burden, along with the care-receiver being 85 years or older, not being able to feed him/herself independently and visits to the emergency room during the previous year. Identified correlates can be useful in targeting dyads likely to behave differently. Communication within these dyads needs to be enhanced, as it is crucial to ensure that both parties are comfortable with possible future institutionalisation. In this regard, health professionals could play a role in bringing the issue to discussion.
Assessing the effectiveness of interventions to promote advance directives among older adults: a systematic review and multi-level analysis
- Authors:
- BRAVO Gina, DUBOIS Marie-France, WAGNEUR Bernard
- Journal article citation:
- Social Science and Medicine, 67(7), October 2008, pp.1122-1132.
- Publisher:
- Elsevier
Many studies have investigated the effectiveness of interventions in promoting advance directives (ADs) but there is uncertainty as to what works best, and in whom. We conducted a systematic review of the evidence in this regard, using both classical meta-analysis approaches and multi-level analyses. Eleven databases were searched for relevant reports published through March 2007. All prospective studies were eligible, whether involving a single group or several and, in the latter case, regardless of the allocation mechanism. Outcomes included formal and informal ADs assessed by chart review or self-report. Heterogeneous sets of outcomes were pooled under a random-effects model. The search yielded 55 studies, half of which targeted outpatients. Most groups of subjects were educated in a single session led by one healthcare professional. Outcomes were measured within six months of the intervention in 73% of cases. The largest set of single-arm studies yielded an overall AD completion rate of 45.6%. Across randomized trials, the largest pooled odds ratio was 4.0, decreasing to 2.6 when all comparative studies were included. Multi-variable analyses identified the provision of oral information over multiple sessions as the most successful intervention. This was true regardless of the target population. These findings support the effectiveness of educational interventions in increasing the formulation of ADs and provide practical advice on how best to achieve this goal.
Opinions regarding who should consent to research on behalf of an older adult suffering from dementia
- Authors:
- BRAVO Gina, PAQUET Mariane, DUBOIS Marie-France
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 2(1), February 2003, pp.49-65.
- Publisher:
- Sage
In many jurisdictions, consent to research on a decisionally incompetent adult can be provided only by the legal guardian. Yet, few cognitively impaired older adults are legally represented. This article reports on a postal survey eliciting the opinions of concerned individuals regarding who should decide whether an incompetent older adult will participate in research. Four groups of people were targeted by the survey: older adults, informal caregivers of cognitively impaired patients, researchers in ageing, and members of institutional review boards. Opinions were similar across the four groups and varied with the degree of risk involved in the study. In the absence of risk, most respondents did not think that the surrogate decision-maker must be legally appointed.