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Home-based physical activity programs for people with dementia: systematic review and meta-analysis
- Authors:
- de ALMEIDA Sara Isabel Lebre, da SILVA Madalena Gomes, MARQUES Alda Sofia Pires de Dias
- Journal article citation:
- Gerontologist, 60(8), 2020, pp.e600-e608.
- Publisher:
- Oxford University Press
Background and Objectives: Physical activity has the potential to improve health outcomes in people with dementia, namely when living at home. However, the knowledge about home-based physical activity for this population is scarce. Thus, we aim to identify and synthesize the effects of home-based physical activity for people with dementia. Research Design and Methods: A systematic review was conducted. Quality of studies was assessed using the Delphi List. Effect sizes (ES) were calculated with MetaXL 2.0. A meta-analysis was conducted for the Mini-Mental Status Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia, Alzheimer’s Disease Cooperative Study Group Activities of Daily Living Scale (ADCS-ADL), Functional Reach test, Timed Up and Go (TUG) test, Short Physical Performance Battery, Dementia Quality of Life, NPI Caregivers subscale and Zarit Burden Interview (ZBI). Results: Sixteen randomized controlled trials were included. Most were of high quality and published after 2015. A large heterogeneity of interventions was found. Meta-analysis showed significant results in MMSE (ES = 0.71, 95% CI 0.43, 0.99), NPI (ES = −0.37, 95% CI −0.57, −0.17), ADCS-ADL (ES = 0.80, 95% CI 0.53, 1.07), Functional Reach test (ES = 2.24, 95% CI 1.80, 2.68), TUG test (ES = −2.40, 95% CI −2.84, −1.96), NPI Caregivers subscale (ES = −0.63, 95% CI −0.94, −0.32), and ZBI (ES = −0.45, 95% CI −0.77, −0.13). Few minor adverse events and high adherence to intervention were found. Discussion and Implications: Home-based physical activity seems safe and effective in delaying cognitive function decline and improving changes in behavioral and psychological symptoms of dementia, activities of daily living, health-related physical fitness, and carer’s burden in people with dementia living at home. (Edited publisher abstract)
Assessing the impact of a restorative home care service in New Zealand: a cluster randomised controlled trial
- Authors:
- KING Anna I. I., et al
- Journal article citation:
- Health and Social Care in the Community, 20(4), July 2012, pp.365-374.
- Publisher:
- Wiley
Restorative care, which focuses on helping clients do things for themselves, is one approach to improving home care services. This study investigated the impact of a restorative home care service for 186 community-dwelling older people who received assistance from a home care agency in New Zealand. A randomised controlled trial was undertaken, where older people were interviewed face-to-face at baseline, four and seven months. Ninety three participants received restorative home care and 93 people received usual home care. Findings revealed that compared with usual care, the intervention demonstrated a statistically significant benefit in health-related quality of life at 7 months for older people. There were no changes in other measurements for older people in either group over time. There was a significant difference in the number of older people in the intervention group identified for reduced hours (29%) compared with the control group (0%). The authors concluded that a restorative home care service may be of benefit to older people, and improve service efficacy.
Engagement in activities: experiences of persons with dementia and their caregiving spouses
- Authors:
- VIKSTROM Sofia, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 7(2), May 2008, pp.251-270.
- Publisher:
- Sage
This study identifies how persons with dementia and their caregiving spouses individually perceive their own, their spouse's and their mutual engagements in everyday activities. Fifty-two cohabiting spouses, half of whom were diagnosed with dementia, were interviewed. A qualitative constant comparative analysis was performed, identifying four major themes: perceived changes in activity engagements; consequences of experienced changes; dilemmas experienced by the caregivers; and management approaches to handle a changed everyday life. Each individual described their activities to include loss of social engagements and changes in the relationship. Dilemmas experienced by the caregivers included `interfering with the spouse's engagement or not' and `placing the spouse's or one's own needs first'. The caregiver management approaches identified included `taking over' or `encouraging initiative'; `lowering demands or avoiding problematic engagements'; and `managing through collaboration'. Findings provide insight into everyday engagements for persons with dementia and their caregivers, important to healthcare support providers.
An evaluation of a specialist multiagency home support service for older people with dementia using qualitative methods
- Authors:
- ROTHERA Ian, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(1), January 2008, pp.65-72.
- Publisher:
- Wiley
Standard home care support for people with dementia has been criticised in statutory inspection reports, and may lead to unnecessary crises, hospital or care home admissions. The aim was to establish whether a specialist multiagency home care service for older people with dementia delivered better quality care than standard services, and how any improvements were achieved. Qualitative study, using semi-structured interviews, focus groups and small group interviews. Two demographically similar areas in Nottingham, one served by a specialist home care team, the other by standard services. Twenty-seven service users, 18 family carers, 17 home care workers, 20 health/social care professionals, across both services. The specialist service demonstrated greater flexibility and responsiveness to the particular needs and circumstances of service users and family carers, who were encouraged to participate in routine decision-making and activities. By sharing responsibilities, the specialist service helped reduce carer stress and prevent crises. These outcomes depended on the configuration of the service, including multidisciplinary health and social services input, careworker autonomy and independence, continuous reassessment of clients' circumstances and preferences and the capacity to develop long-term relationships, through careworker continuity. The standard service, which used a task-orientated approach, lacked these characteristics. This study provides evidence of the benefits of a specialist multiagency home support service over standard home care, in the opinion of service users, carers and careworkers, and defines the operational model that achieves this. Findings confirm best practice recommendations, based on models of dementia care which emphasise respect for personhood.
Effects of combined intervention programmes for people with dementia living at home and their caregivers: a systematic review
- Authors:
- SMITS Carolien H. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(12), December 2007, pp.1181-1193.
- Publisher:
- Wiley
This study reviews the evidence for effects of combined intervention programmes for both the informal caregiver and the person with dementia. Electronic databases and key articles were searched for effect studies of combined programmes, published between January 1992 and February 2005. The resulting 52 reports were scored according to set inclusion criteria. Twenty five reports relating to 22 programmes met the inclusion criteria. Various aspects of caregivers' mental health and burden were studied. Best results were obtained regarding general mental health. Other aspects often showed modest and varying results. Caregivers' competence was less often addressed. The effects on the cognitive and physical functioning, behavioural problems and survival of the persons with dementia were modest and inconsistent, whereas their mental health is positively affected and admittance to long stay care is often delayed. Combined programmes may improve some, not all, aspects of functioning for caregiver and person with dementia. Care professionals must define their programme goals and target groups before advising their clients on a combined programme. Research may focus on the effects of programmes that were introduced fairly recently and on subgroups of caregivers (female caregivers, depressed caregivers and people with dementia, and minorities).
Predictors of change and continuity in home care for dementia patients
- Authors:
- VERNOOIJ-DASSEN Myrra, FELLING Albert, PERSOON Jean
- Journal article citation:
- International Journal of Geriatric Psychiatry, 12(6), June 1997, pp.671-677.
- Publisher:
- Wiley
Discusses the results of a study to investigate predictors of change in the sense of competence of primary caregivers and continuity in home care for dementia patients in the Netherlands. Regression analysis revealed that a change in the caregiver's sense of competence was independently predicted by characteristics of the patient, the primary caregiver and the professional social network. A decreased sense of competence was associated with a longer duration of dementia and the patient's more agitated behaviour, the caregiver's higher initial sense of competence and being a female caregiver sharing a household with the demented patient. Concludes that caregiver characteristics influenced the change in sense of competence but did not influence the risk for institutionalisation. Findings suggest that health professionals should pay attention to the negative consequences of agitated behaviour and to the most vulnerable group, females sharing a household with the demented patient.
Intervening to reduce distress in caregivers of impaired elderly people: a preliminary evaluation
- Authors:
- HARPER David J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 8(2), February 1993, pp.139-145.
- Publisher:
- Wiley
Preliminary results from a longitudinal study of distress in carers receiving home care support has indicated that simplistic models of stress and coping need to be replaced by research which considers diversity in caregiver distress and the subtle changes in distress over time.
Integration in action: housing services to enable people to stay living independently at home. Homewise Memory Matters: supporting people with memory loss, dementia and their carers at home in East Lancashire
- Author:
- CARE AND REPAIR ENGLAND
- Publisher:
- Care and Repair England
- Publication year:
- 2017
- Pagination:
- 6
- Place of publication:
- Nottingham
This briefing describes the Homewise Memory Matters project for people with memory loss, dementia and their carers. The project supports people with memory loss and dementia to stay at home continuing to live independently keeping them safe and out of hospital and residential care. It also works with their carers to ensure that they are aware of local services including respite care and have a network of support available to them. Project outcomes include: prevention of hospital admission e.g. reduced falls risk; reduced risk of admission to residential care; extended independent living at home; improved wellbeing including support for carers; improved safety and security at home; and reduction in social isolation. (Edited publisher abstract)
Keys to person-centred care to persons living with dementia – experiences from an educational program in Sweden
- Authors:
- BERGLUND M., GILLSJO Catharina, SVANSTROM Rune
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(7-8), 2019, pp.2695-2709.
- Publisher:
- Sage
Growing old entails an increased risk of disabilities and illnesses such as dementia. The orientation in Sweden on national level is that individuals remain in their own homes if desired and receive person-centred home care. The aim of this study was to describe the experience of an educational program and its influence on daily provision of care to persons with dementia. A life-world approach was used. Data were collected through group interviews with care providers in the context of home. The findings are presented in five themes: Increased knowledge about dementia and treatment, Relationship-building in order to provide good care, Open and flexible approach conveys calm, Continuity and flexibility are cornerstones in the care and Perceived improvements. This person-centred educational intervention resulted in a care that was based on each individual’s personality, preferences and priorities in life. Education given with continuity over time is key to improving provision of care to person with dementia. (Edited publisher abstract)
No place like home: a systematic review of home care for older adults in Canada
- Authors:
- JOHNSON Shanthi, et al
- Journal article citation:
- Canadian Journal on Aging, September 2018, pp.1-20.
- Publisher:
- Canadian Association on Gerontology
- Place of publication:
- Kanata
Given Canada’s aging population, the demand for home care is expected to increase significantly. To date, little is known about home care for older adults in Canada such as characteristics of home care recipients, gaps in services, or interventions designed to support home care client needs. A systematic review was conducted of seven electronic databases for the years 2000–2016 to examine the current knowledge of home care services for Canada’s older adults. This synthesis examined four main themes in the literature: older adult client-level predictors; unmet care needs; interventions; and issues and challenges in home care. This review found significant knowledge gaps on home care for older adults across the country, as over half of the studies were focused primarily in Ontario. Although promising strategies were evident, more research and evaluation of interventions, and outcomes are required to effectively support Canada’s home care system now and over time. (Edited publisher abstract)