Globally, hospital length of stay is decreasing, yet the number of aged patients requiring complex care is increasing. This causes more patients, and their informal caregivers, to self-manage in the community following acute care discharge. This study aims to assess whether transitional care programs that integrate caregivers provide better value care than routine care. In this systematic review, Medline Ovid, EMBASE Ovid, CINAHL EbscoHOST, Scopus, and Proquest were searched for any study design that investigated a caregiver inclusive transitional care intervention in a population of people with geriatric syndrome, enroled a comparator group, and assessed population health, experience, and/or cost related outcomes. Risk of bias was assessed by two reviewers using ROBINS I and RoB 2. The review included 23 studies and results were mixed. Consistently positive results occurred for patient and caregiver satisfaction. Cost tended to increase with caregiver inclusive practices. Most studies found no difference in population health outcomes. There was insufficient evidence on healthcare professional experience. Currently, there is insufficient evidence to determine whether caregiver inclusive transitions of care provide better value care than routine care. Studies that rigorously implement and evaluate caregiver inclusive care models are urgently required to inform future policy.
(Edited publisher abstract)
Globally, hospital length of stay is decreasing, yet the number of aged patients requiring complex care is increasing. This causes more patients, and their informal caregivers, to self-manage in the community following acute care discharge. This study aims to assess whether transitional care programs that integrate caregivers provide better value care than routine care. In this systematic review, Medline Ovid, EMBASE Ovid, CINAHL EbscoHOST, Scopus, and Proquest were searched for any study design that investigated a caregiver inclusive transitional care intervention in a population of people with geriatric syndrome, enroled a comparator group, and assessed population health, experience, and/or cost related outcomes. Risk of bias was assessed by two reviewers using ROBINS I and RoB 2. The review included 23 studies and results were mixed. Consistently positive results occurred for patient and caregiver satisfaction. Cost tended to increase with caregiver inclusive practices. Most studies found no difference in population health outcomes. There was insufficient evidence on healthcare professional experience. Currently, there is insufficient evidence to determine whether caregiver inclusive transitions of care provide better value care than routine care. Studies that rigorously implement and evaluate caregiver inclusive care models are urgently required to inform future policy.
(Edited publisher abstract)
Subject terms:
carers, older people, service transitions, comorbidity;
Disability and Rehabilitation: Assistive Technology, 11(5), 2016, pp.353-360.
Publisher:
Taylor and Francis
Place of publication:
London
Aim: The world population is rapidly ageing. As population age, the incidence of functional limitations increases, demanding higher levels of care from caregivers. Assistive technologies improve individuals’ functioning, independence, well-being and quality of life. By increasing independence of older adults, assistive technologies decrease workloads required from informal caregivers. This review investigates, evaluates, and synthesises existing findings to examine whether and how assistive technologies reduce caregiver burden. Methods: Databases searched included MEDLINE, EMBASE, Scopus, and Cochrane Library. Three groups of keywords were combined: those relating to assistive technology, caregiver burden, and older adults. Results: Two theories emerged from the analysis of study results. Caregivers reported that assistive technologies decrease caregiver burden. However, caregivers had concerns that assistive technologies could add to caregiver burden, highlighting the limitations of assistive technology. Conclusions: As suggested by a majority of the studies in this review, assistive technologies contribute to reducing caregiver burden among caregivers of older adults. Assistive technologies assisted caregivers by reducing time, levels of assistance and energy put towards caregiving, anxiety and fear, task difficulty, safety risk particularly for activities requiring physical assistance and increasing the independence of the users. Further research is required to better understand limitations of assistive technologies.
(Publisher abstract)
Aim: The world population is rapidly ageing. As population age, the incidence of functional limitations increases, demanding higher levels of care from caregivers. Assistive technologies improve individuals’ functioning, independence, well-being and quality of life. By increasing independence of older adults, assistive technologies decrease workloads required from informal caregivers. This review investigates, evaluates, and synthesises existing findings to examine whether and how assistive technologies reduce caregiver burden. Methods: Databases searched included MEDLINE, EMBASE, Scopus, and Cochrane Library. Three groups of keywords were combined: those relating to assistive technology, caregiver burden, and older adults. Results: Two theories emerged from the analysis of study results. Caregivers reported that assistive technologies decrease caregiver burden. However, caregivers had concerns that assistive technologies could add to caregiver burden, highlighting the limitations of assistive technology. Conclusions: As suggested by a majority of the studies in this review, assistive technologies contribute to reducing caregiver burden among caregivers of older adults. Assistive technologies assisted caregivers by reducing time, levels of assistance and energy put towards caregiving, anxiety and fear, task difficulty, safety risk particularly for activities requiring physical assistance and increasing the independence of the users. Further research is required to better understand limitations of assistive technologies.
(Publisher abstract)
Aging and Mental Health, 11(2), March 2007, pp.205-217.
Publisher:
Taylor and Francis
This multi-study analysis systematically examines research findings on relationships between social support and caregiver adjustment to discover whether informal support helps family caregivers. Caring for older relatives is an ongoing stressful life course event and role. Informal social support is often used as a predictor of caregiver adjustment outcomes. It is widely believed to enhance adjustment. Yet the varied research results do not necessarily support this belief. A computer-generated literature search of social sciences and medical databases produced thirty-five caregiving articles, published in refereed journals, which meet study parameters. A coding form was developed to categorize social support and adjustment variables for cross-tabular analyses. The findings show most relationships (61%) between social support and caregiver adjustment are not positively significant. Of the minority of positively significant relationships, neither perceived (available) nor received support is more important and neither instrumental nor socioemotional support is more likely to aid adjustment. Researchers and health care professionals need to explore the negative impact of social support and attributes of caregiver-care recipient relationships.
This multi-study analysis systematically examines research findings on relationships between social support and caregiver adjustment to discover whether informal support helps family caregivers. Caring for older relatives is an ongoing stressful life course event and role. Informal social support is often used as a predictor of caregiver adjustment outcomes. It is widely believed to enhance adjustment. Yet the varied research results do not necessarily support this belief. A computer-generated literature search of social sciences and medical databases produced thirty-five caregiving articles, published in refereed journals, which meet study parameters. A coding form was developed to categorize social support and adjustment variables for cross-tabular analyses. The findings show most relationships (61%) between social support and caregiver adjustment are not positively significant. Of the minority of positively significant relationships, neither perceived (available) nor received support is more important and neither instrumental nor socioemotional support is more likely to aid adjustment. Researchers and health care professionals need to explore the negative impact of social support and attributes of caregiver-care recipient relationships.
Objective: The objective of this review was to investigate the effectiveness of caregiver-provided individual cognitive interventions for improving cognition, social functioning and quality of life in older adults with major neurocognitive disorders. Introduction: A large number of people with major neurocognitive disorders live in their homes, requiring ongoing community care. Different individual cognitive intervention programs have been explored as a potential approach for implementation by caregivers on a one-to-one basis. These programs have the advantage of being implemented in a home setting and in the real-life context of the older adult, in a society that is increasingly aging and where aging in place is being fostered. Inclusion criteria: This review considered experimental studies that included older adults aged 60 years and over with major neurocognitive disorders who were receiving individual cognitive interventions (e.g. cognitive stimulation, cognitive training or cognitive rehabilitation) provided by their caregivers. The comparator was usual care, wait-list control or alternative therapeutic intervention. The primary outcomes of interest included cognition, social functioning and quality of life. Additionally, behavior, mood and activities of daily living were considered. Methods: A comprehensive search strategy was used to identify relevant published and unpublished studies from January 1995 to March 2018, written in English, Spanish and Portuguese. Studies meeting the inclusion criteria were retrieved and their methodological quality was assessed by two independent reviewers using the JBI critical appraisal checklists for randomized controlled trials and quasi-experimental studies. Quantitative data were extracted using the standardized data extraction tool from the JBI System for the Unified Management, Assessment and Review of Information. Due to the clinical and methodological heterogeneity in the included studies, statistical pooling was not possible. Therefore, findings are presented in a narrative format. Results: Eight randomized controlled trials and two quasi-experimental studies were included, with a total sample of 844 dyads (older adults and caregivers). The number of dyads included in the studies ranged from 16 to 356. Beneficial effects of the caregiver-provided individual cognitive interventions were observed in various cognitive domains, including memory, attention, verbal fluency and problem-solving. Two studies additionally reported the positive impact of the intervention of interest on general cognitive functioning. None of the reviewed studies revealed significant changes in quality of life. Social functioning was not analyzed in any of the included studies. Beneficial effects were also reported in relation to behavior and activities of daily living, despite the low level of evidence. Conclusions: This review responds to a gap in current international literature on the synthesis of evidence on the use of caregiver-provided individual cognitive interventions. The intervention of interest is associated with improvement in cognitive performance, revealing some benefits for the stabilization of neuropsychiatric symptoms and an increase in autonomy in activities of daily living. Further research on the impact of sociodemographic and clinical factors on the intervention effects is needed, as these factors seem to interfere with successful intervention implementation. To reinforce current evidence, the methodological quality of future studies should be improved.
(Edited publisher abstract)
Objective: The objective of this review was to investigate the effectiveness of caregiver-provided individual cognitive interventions for improving cognition, social functioning and quality of life in older adults with major neurocognitive disorders. Introduction: A large number of people with major neurocognitive disorders live in their homes, requiring ongoing community care. Different individual cognitive intervention programs have been explored as a potential approach for implementation by caregivers on a one-to-one basis. These programs have the advantage of being implemented in a home setting and in the real-life context of the older adult, in a society that is increasingly aging and where aging in place is being fostered. Inclusion criteria: This review considered experimental studies that included older adults aged 60 years and over with major neurocognitive disorders who were receiving individual cognitive interventions (e.g. cognitive stimulation, cognitive training or cognitive rehabilitation) provided by their caregivers. The comparator was usual care, wait-list control or alternative therapeutic intervention. The primary outcomes of interest included cognition, social functioning and quality of life. Additionally, behavior, mood and activities of daily living were considered. Methods: A comprehensive search strategy was used to identify relevant published and unpublished studies from January 1995 to March 2018, written in English, Spanish and Portuguese. Studies meeting the inclusion criteria were retrieved and their methodological quality was assessed by two independent reviewers using the JBI critical appraisal checklists for randomized controlled trials and quasi-experimental studies. Quantitative data were extracted using the standardized data extraction tool from the JBI System for the Unified Management, Assessment and Review of Information. Due to the clinical and methodological heterogeneity in the included studies, statistical pooling was not possible. Therefore, findings are presented in a narrative format. Results: Eight randomized controlled trials and two quasi-experimental studies were included, with a total sample of 844 dyads (older adults and caregivers). The number of dyads included in the studies ranged from 16 to 356. Beneficial effects of the caregiver-provided individual cognitive interventions were observed in various cognitive domains, including memory, attention, verbal fluency and problem-solving. Two studies additionally reported the positive impact of the intervention of interest on general cognitive functioning. None of the reviewed studies revealed significant changes in quality of life. Social functioning was not analyzed in any of the included studies. Beneficial effects were also reported in relation to behavior and activities of daily living, despite the low level of evidence. Conclusions: This review responds to a gap in current international literature on the synthesis of evidence on the use of caregiver-provided individual cognitive interventions. The intervention of interest is associated with improvement in cognitive performance, revealing some benefits for the stabilization of neuropsychiatric symptoms and an increase in autonomy in activities of daily living. Further research on the impact of sociodemographic and clinical factors on the intervention effects is needed, as these factors seem to interfere with successful intervention implementation. To reinforce current evidence, the methodological quality of future studies should be improved.
(Edited publisher abstract)
International Journal of Integrated Care, 12(3), 2012, Online only
Publisher:
International Foundation for Integrated Care
Many community-dwelling frail elderly are being cared for by informal caregivers. However, caring can be challenging, causing physical and mental health problems, financial problems and social isolation. The aim of this paper is to review the current best evidence on the effectiveness of different types of support services targeting informal caregivers of community-dwelling frail elderly. Following a systematic literature search, 4 review articles and 10 articles describing primary studies were selected for inclusion in this review. The 4 review articles cover: respite services; psychosocial interventions (individual and group); and information and communication technology support services. The 10 primary studies report on psychosocial support interventions providing education, information, coordination, counselling, psychological and emotional support, either in group or at the individual caregiver level. The findings on the 3 main types of support (respite, psychosocial, and ICT) are discussed. They suggest that the effect of caregiver support interventions is small and also inconsistent between studies. The review concludes that integrated support packages where the content of the package is tailored to the individual caregivers' physical, psychological and social needs should be preferred when supporting informal caregivers of frail elderly.
Many community-dwelling frail elderly are being cared for by informal caregivers. However, caring can be challenging, causing physical and mental health problems, financial problems and social isolation. The aim of this paper is to review the current best evidence on the effectiveness of different types of support services targeting informal caregivers of community-dwelling frail elderly. Following a systematic literature search, 4 review articles and 10 articles describing primary studies were selected for inclusion in this review. The 4 review articles cover: respite services; psychosocial interventions (individual and group); and information and communication technology support services. The 10 primary studies report on psychosocial support interventions providing education, information, coordination, counselling, psychological and emotional support, either in group or at the individual caregiver level. The findings on the 3 main types of support (respite, psychosocial, and ICT) are discussed. They suggest that the effect of caregiver support interventions is small and also inconsistent between studies. The review concludes that integrated support packages where the content of the package is tailored to the individual caregivers' physical, psychological and social needs should be preferred when supporting informal caregivers of frail elderly.
Extended abstract:
Author
LOPEZ-HARTMANN Maja; et al.;
Title
The effect of caregiver support interventions for informal caregivers of community-dwelling frail elderly: a systematic review.
Journal citation/publication details
International Journal of Integrated Care, 12, July-September 2012. Online only.
Summary
The evidence for this systematic review comes from four systematic reviews and ten primary studies conducted in ‘developed’ countries. Evidence of beneficial caregiver outcomes are reported for respite care, psychosocial interventions, and for support using information and communication technology. However the heterogeneity of the interventions is such that there is no clear indication of what constitutes the best caregiver support. One of the main weaknesses of the study was that the search strategy was limited by the use of the very specific search term ‘frail elderly’. The concept of integrated services as they apply to informal caregivers of frail elderly people is discussed.
Context
Informal care givers are an important resource for helping elderly people to continue to live at home. The challenge of caring, can however, lead to caregiver problems such as depression, stress, and burnout. Interventions aimed at providing support for informal caregivers have been systematically reviewed, but have tended to target caregivers of patients with specific health problems, or specific types of informal caregiver support. The aim of this study was “to broadly review the current best evidence on different types of support services targeting informal caregivers of community-dwelling frail elderly”.
Methods
What sources were searched? Searches were conducted on the following electronic databases: Medline, PsycINFO, Ovid Nursing Database, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and the British Nursing Index.
What search terms/strategies were used? Controlled terms and keywords for informal caregivers, frail elderly, caregiver needs and support interventions were used in combination. Searches were carried out in September 2010 and were limited to reviews and original research on effectiveness published in English, French, German, or Dutch. Detailed search strategies for each of the databases are included in a table.
What criteria were used to decide on which studies to include? Studies had to focus on support services for informal caregivers of community-dwelling, frail, elderly people. There was no limit on the type of support services on offer or on the caregiver-related outcomes reported. The definition of a ‘community-dwelling frail elder’ used is that of a vulnerable older person living at home, who is dependent on others in the long-term for at least one of the Activities of Daily Life. Studies conducted in developing countries were excluded. Reviews and original research were eligible for inclusion in the systematic review.
Who decided on their relevance and quality? References were screened by title and abstract by two named authors. Potentially relevant studies were obtained in full for further examination and quality assessment. Methodological quality was assessed using the Scottish Intercollegiate Guidelines Network checklists by two sets of two researchers working independently. Quality scores were reached through consensus and articles scoring ten out of a possible fifteen were included in the systematic review.
How many studies were included and where were they from? A total of 696 records remained after the removal of duplicates. In all, 226 records included the term review, 17 of which were selected for further examination. Four reviews were eventually selected for inclusion. Seventy-one other articles were obtained for full-text assessment; 24 were retained for quality assessment and ten studies were included in the systematic review. There is no indication of where the intervention studies were conducted.
How were the study findings combined?
The review is narrative in nature and presents an overview of the outcomes and the different types of caregiver support reported in the literature. Only outcomes measured in at least two different studies are reported. The types of support are examined under the headings: respite, psychosocial support, and information and communication technology. Individual study details including the design, research question, intervention, and caregiver-related outcome measures and instruments are tabulated.
Findings of the review
The number of study participants ranged from 25 to 153. Between one and twelve different outcome variables were used in each study. The most commonly measured outcomes were caregiver depression and caregiver burden; three different measurements were reported for the former and six different scales were used with the latter.
Respite The evidence on interventions involving respite care comes from two systematic reviews. Beneficial effects are reported for caregiver burden, anger towards the care recipient while negative effects were found for anxiety and caregiver quality of life.
Psychosocial support Psychosocial support, aimed at helping caregivers manage the caregiving situation, was delivered at an individual level, usually in the caregivers’ home, or as a group intervention. At the individual level, positive effects on depression, burden, stress and role strain were reported. While at the group level improvements in coping, knowledge, social support, and depression were found; inconsistent findings are reported for caregiver burden.
Information and communication technology
ICT interventions such as telephone and computer services providing support and education to caregivers were reported in two systematic reviews; benefits included a reduction in depression, anxiety, and caregiver burden in one and, an improvement in caregiver stress and coping in the other.
Authors' conclusions
“Some evidence exists for the effectiveness of respite care, interventions at individual caregiver level, group support and information and communication technology. Overall, the effect of caregiver support interventions is small and also inconsistent between studies.”
Implications for policy or practice
None are discussed.
Subject terms:
information technology, older people, psychosocial intervention, short break care, carers;
Journal of Elder Abuse and Neglect, 21(3), July 2009, pp.187-210.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
The purpose of this study was to use rigorous systematic review methods to summarise the effectiveness of interventions for elder abuse. Only eight studies met the inclusion criteria. Evidence regarding the recurrence of abuse following intervention was limited, but the interventions for which this outcome was reported failed to reduce, and may even have increased, the likelihood of recurrence. Elder abuse interventions had no significant effect on case resolution and at-risk carer outcomes, and had mixed results regarding professional knowledge and behaviour related to elder abuse. The studies had significant methodological limitations that limit the ability to draw conclusions about the effectiveness of these interventions.
The purpose of this study was to use rigorous systematic review methods to summarise the effectiveness of interventions for elder abuse. Only eight studies met the inclusion criteria. Evidence regarding the recurrence of abuse following intervention was limited, but the interventions for which this outcome was reported failed to reduce, and may even have increased, the likelihood of recurrence. Elder abuse interventions had no significant effect on case resolution and at-risk carer outcomes, and had mixed results regarding professional knowledge and behaviour related to elder abuse. The studies had significant methodological limitations that limit the ability to draw conclusions about the effectiveness of these interventions.
International Journal of Nursing Studies, 123, 2021, p.104062.
Publisher:
Elsevier
Background: Community dwelling older adults who are care dependent are highly affected by incontinence, resulting in substantial informal caregiver burden. Understanding the experiences of these caregivers is needed to develop supportive programs that reduce caregiver burden and rates of institutionalization for care recipients. Objectives: This systematic review aimed to critically appraise and synthesize the qualitative literature on the perceptions, experiences, and consequences of informal caregivers managing incontinence in community dwelling older adults. Design: A qualitative evidence synthesis using meta-aggregation. Data sources: CINAHL, Embase, Ovid Medline, PsycInfo, Scopus, and ProQuest Dissertations and Theses. Review methods: A comprehensive search was conducted to identify qualitative studies of all designs, published in English from January 1970 to November 2020, reporting on the experiences of unpaid adult family members or friends providing care at home to an adult aged 60 or older with urinary and/or fecal incontinence. Screening, data extraction, and quality appraisal were conducted independently by two reviewers, with disagreements resolved by consensus with all team members. Joanna Briggs Institute (JBI) processes were used to assess study quality, and the dependability and credibility of both study findings and synthesized findings. All articles included met predetermined criteria. Results: Database searches yielded 1165 references, of which 117 full-text documents were screened. Seven articles of moderate to high methodological quality met eligibility criteria and were included. Studies occurred in nine countries with 134 participants who were mostly female spouses of the care recipient. From these eligible studies, 49 findings were extracted with 35 equivocal or credible findings eligible for meta-aggregation. Findings were synthesized into the following four categories: 1) emotional responses, 2) physical, financial, and social consequences, 3) family roles and caregiver support, and 4) management and coping strategies. Conclusions: Informal caregivers experience many physical, psychosocial, and financial challenges in caring for an older family member with incontinence. Educational and supportive programs for managing incontinence should be multi-component and tailored to meet the individual needs of informal caregivers. Future research should incorporate strategies to cope with emotional responses and offer practical strategies for managing incontinence.
(Edited publisher abstract)
Background: Community dwelling older adults who are care dependent are highly affected by incontinence, resulting in substantial informal caregiver burden. Understanding the experiences of these caregivers is needed to develop supportive programs that reduce caregiver burden and rates of institutionalization for care recipients. Objectives: This systematic review aimed to critically appraise and synthesize the qualitative literature on the perceptions, experiences, and consequences of informal caregivers managing incontinence in community dwelling older adults. Design: A qualitative evidence synthesis using meta-aggregation. Data sources: CINAHL, Embase, Ovid Medline, PsycInfo, Scopus, and ProQuest Dissertations and Theses. Review methods: A comprehensive search was conducted to identify qualitative studies of all designs, published in English from January 1970 to November 2020, reporting on the experiences of unpaid adult family members or friends providing care at home to an adult aged 60 or older with urinary and/or fecal incontinence. Screening, data extraction, and quality appraisal were conducted independently by two reviewers, with disagreements resolved by consensus with all team members. Joanna Briggs Institute (JBI) processes were used to assess study quality, and the dependability and credibility of both study findings and synthesized findings. All articles included met predetermined criteria. Results: Database searches yielded 1165 references, of which 117 full-text documents were screened. Seven articles of moderate to high methodological quality met eligibility criteria and were included. Studies occurred in nine countries with 134 participants who were mostly female spouses of the care recipient. From these eligible studies, 49 findings were extracted with 35 equivocal or credible findings eligible for meta-aggregation. Findings were synthesized into the following four categories: 1) emotional responses, 2) physical, financial, and social consequences, 3) family roles and caregiver support, and 4) management and coping strategies. Conclusions: Informal caregivers experience many physical, psychosocial, and financial challenges in caring for an older family member with incontinence. Educational and supportive programs for managing incontinence should be multi-component and tailored to meet the individual needs of informal caregivers. Future research should incorporate strategies to cope with emotional responses and offer practical strategies for managing incontinence.
(Edited publisher abstract)
Subject terms:
carers, incontinence, older people, systematic reviews, informal care, qualitative research;
Background and Objectives: Although most people have some experience as caregivers, the nature and context of care are highly variable. Caregiving, socioeconomic factors, and health are all interrelated. For these reasons, caregiver interventions must consider these factors. This review examines the degree to which caregiver intervention research has reported and considered social determinants of health. Research Design and Methods: The researchers examined published systematic reviews and meta-analyses of interventions for older adults with age-related chronic conditions using the PRISMA and AMSTAR 2 checklists. From 2,707 papers meeting search criteria, the researchers identified 197 potentially relevant systematic reviews, and selected 33 for the final analysis. Results: The researchers found scant information on the inclusion of social determinants; the papers lacked specificity regarding race/ethnicity, gender, sexual identity, socioeconomic status, and geographic location. The majority of studies focused on dementia, with other conditions common in later life vastly underrepresented. Discussion and Implications: Significant gaps in evidence persist, particularly for interventions targeting diverse conditions and populations. To advance health equity and improve the effectiveness of interventions, research should address caregiver heterogeneity and improve assessment, support, and instruction for diverse populations. Research must identify aspects of heterogeneity that matter in intervention design, while recognising opportunities for common elements and strategies.
(Edited publisher abstract)
Background and Objectives: Although most people have some experience as caregivers, the nature and context of care are highly variable. Caregiving, socioeconomic factors, and health are all interrelated. For these reasons, caregiver interventions must consider these factors. This review examines the degree to which caregiver intervention research has reported and considered social determinants of health. Research Design and Methods: The researchers examined published systematic reviews and meta-analyses of interventions for older adults with age-related chronic conditions using the PRISMA and AMSTAR 2 checklists. From 2,707 papers meeting search criteria, the researchers identified 197 potentially relevant systematic reviews, and selected 33 for the final analysis. Results: The researchers found scant information on the inclusion of social determinants; the papers lacked specificity regarding race/ethnicity, gender, sexual identity, socioeconomic status, and geographic location. The majority of studies focused on dementia, with other conditions common in later life vastly underrepresented. Discussion and Implications: Significant gaps in evidence persist, particularly for interventions targeting diverse conditions and populations. To advance health equity and improve the effectiveness of interventions, research should address caregiver heterogeneity and improve assessment, support, and instruction for diverse populations. Research must identify aspects of heterogeneity that matter in intervention design, while recognising opportunities for common elements and strategies.
(Edited publisher abstract)
Subject terms:
intervention, carers, health inequalities, socioeconomic groups, older people, systematic reviews, long term conditions;
Journal of Advanced Nursing, 74(3), 2018, pp.507-527.
Publisher:
Blackwells Publishing
AIM: The aim of this study was to explicate the outcomes of home support interventions for older people with dementia and/or their carers to inform clinical practice, policy and research. BACKGROUND: Most people with dementia receive support at home. However, components and effectiveness of home support interventions have been little explored. DESIGN: Systematic review with narrative summary. DATA SOURCES: Electronic searches of published studies in English using PubMed, Cochrane Central Register of Controlled Trials, PsychINFO, CINAHL, Applied Social Science Index and CSA Social Services Abstracts. Databases and sources were searched from inception to April 2014 with no date restrictions to locate studies. REVIEW METHODS: The PRISMA statement was followed and established systematic review methods used. Using 14 components of care for people with dementia and their carers, identified previously, data across studies were synthesized. Interventions were grouped and described and effectiveness ratings applied. Qualitative studies were synthesized using key themes. RESULTS: Seventy studies (four qualitative) were included. Most were directed to carers and of high quality. Seven interventions for carers and two for people with dementia were identified, covering 81% of studies. Those relating to daily living, cognitive training and physical activity for people with dementia were absent. Measures of effectiveness were influenced mainly by the intensity (duration and frequency) of interventions. Those containing education, social support and behaviour management appeared most effective. CONCLUSION:
These interventions reflect emergent patterns of home support. Research is required to identify effective interventions linked to the stage of dementia, which can be applied as part of routine clinical care.
(Edited publisher abstract)
AIM: The aim of this study was to explicate the outcomes of home support interventions for older people with dementia and/or their carers to inform clinical practice, policy and research. BACKGROUND: Most people with dementia receive support at home. However, components and effectiveness of home support interventions have been little explored. DESIGN: Systematic review with narrative summary. DATA SOURCES: Electronic searches of published studies in English using PubMed, Cochrane Central Register of Controlled Trials, PsychINFO, CINAHL, Applied Social Science Index and CSA Social Services Abstracts. Databases and sources were searched from inception to April 2014 with no date restrictions to locate studies. REVIEW METHODS: The PRISMA statement was followed and established systematic review methods used. Using 14 components of care for people with dementia and their carers, identified previously, data across studies were synthesized. Interventions were grouped and described and effectiveness ratings applied. Qualitative studies were synthesized using key themes. RESULTS: Seventy studies (four qualitative) were included. Most were directed to carers and of high quality. Seven interventions for carers and two for people with dementia were identified, covering 81% of studies. Those relating to daily living, cognitive training and physical activity for people with dementia were absent. Measures of effectiveness were influenced mainly by the intensity (duration and frequency) of interventions. Those containing education, social support and behaviour management appeared most effective. CONCLUSION:
These interventions reflect emergent patterns of home support. Research is required to identify effective interventions linked to the stage of dementia, which can be applied as part of routine clinical care.
(Edited publisher abstract)
Subject terms:
systematic reviews, home care, older people, carers, intervention, nursing, dementia;
Health and Social Care in the Community, 25(2), 2017, pp.295-308.
Publisher:
Wiley
In England and Wales, decision-making in cases of uncertain mental capacity is regulated by the Mental Capacity Act 2005. The Act provides a legal framework for decision-making for adults (16 and over) who are shown to lack capacity and where best interest decisions need to be made on their behalf. Frail older people with cognitive impairments represent a growing demographic sector across England and Wales for whom the protective principles of the Act have great relevance, as they become increasingly dependent on the care of others. However, while the Act articulates core principles, applying the Act in everyday healthcare contexts raises challenges for care providers in terms of interpretation and application. This paper presents a review of the published evidence documenting the use of the Act in healthcare practice, with particular reference to frail older people. The aim was to identify, review and critically evaluate published empirical studies concerned with the implementation and application of the Act in healthcare settings. A systematic approach was undertaken with pre-determined exclusion and inclusion criteria applied across five electronic bibliographic databases combined with a manual search of specific journals. This review reports on 38 empirical sources which met the inclusion criteria published between 2005 and 2013. From the 38 sources, three descriptive themes were identified: knowledge and understanding, implementation and tensions in applying the Act, and alternative perspectives of the Act. There is a need for improved knowledge and conceptualisation to enable successful incorporation of the Act into everyday care provision. Inconsistencies in the application of the Act are apparent across a variety of care settings. This review suggest staff need more opportunities to engage, learn and implement the Act, in order for it to have greater resonance to their individual practice and ultimately benefit patient care.
(Publisher abstract)
In England and Wales, decision-making in cases of uncertain mental capacity is regulated by the Mental Capacity Act 2005. The Act provides a legal framework for decision-making for adults (16 and over) who are shown to lack capacity and where best interest decisions need to be made on their behalf. Frail older people with cognitive impairments represent a growing demographic sector across England and Wales for whom the protective principles of the Act have great relevance, as they become increasingly dependent on the care of others. However, while the Act articulates core principles, applying the Act in everyday healthcare contexts raises challenges for care providers in terms of interpretation and application. This paper presents a review of the published evidence documenting the use of the Act in healthcare practice, with particular reference to frail older people. The aim was to identify, review and critically evaluate published empirical studies concerned with the implementation and application of the Act in healthcare settings. A systematic approach was undertaken with pre-determined exclusion and inclusion criteria applied across five electronic bibliographic databases combined with a manual search of specific journals. This review reports on 38 empirical sources which met the inclusion criteria published between 2005 and 2013. From the 38 sources, three descriptive themes were identified: knowledge and understanding, implementation and tensions in applying the Act, and alternative perspectives of the Act. There is a need for improved knowledge and conceptualisation to enable successful incorporation of the Act into everyday care provision. Inconsistencies in the application of the Act are apparent across a variety of care settings. This review suggest staff need more opportunities to engage, learn and implement the Act, in order for it to have greater resonance to their individual practice and ultimately benefit patient care.
(Publisher abstract)
Subject terms:
older people, Mental Capacity Act 2005, health care, decision making, mental capacity, health professionals, carers;