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Admission to long-stay residential care and mortality among people with and without dementia living at home but on the boundary of residential care: a competing risks survival analysis
- Authors:
- CARTER L, et al
- Journal article citation:
- Aging and Mental Health, 25(10), 2021, pp.1869-1876.
- Publisher:
- Taylor and Francis
Background: Health policy in many countries is underpinned by a commitment to support dependent older people to remain in their own home for as long as possible and practicable. This study explores factors affecting both admission to long-stay residential care (LSRC) and mortality among people with and without dementia who are currently living at home with intensive formal care support. Methods: This is a cross-sectional study based on administrative data collected on 429 dependent older people in Ireland, 269 of whom were people with dementia. A cause-specific hazard model was used to investigate the hazard of admission to LSRC, while accounting for mortality as a competing risk and vice versa. Results: Admission to LSRC was higher for people with dementia relative to people without and for those receiving lower amounts of informal care. The hazard of mortality was significantly higher for older people aged 85+, whereas it was lower for individuals with a medium level of dependency relative to those with high levels of dependency. The hazard of mortality was also influenced by the amount of informal care provision. Conclusion: People with dementia are more likely to be admitted to LSRC than people without. Care for people with dementia needs to be more specialised and personal, and intensity of provision should not be equated to the number of care hours on offer. Informal care provision may help to prevent admission to LSRC. Advanced age, physical dependency and informal care provision affect mortality, raising interesting issues in relation to resource allocation. (Edited publisher abstract)
Estimating the economic and social costs of dementia in Ireland
- Authors:
- CONNOLLY Sheelah, GILLESPIE Paddy
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 13(1), 2014, pp.5-22.
- Publisher:
- Sage
Dementia is a costly condition and one that differs from other conditions in the significant cost burden placed on informal caregivers. The aim of this analysis was to estimate the economic and social costs of dementia in Ireland in 2010. With an estimate of 41,470 people with dementia, the total baseline annual cost was found to be over €1.69 billion, 48% of which was attributable to the opportunity cost of informal care provided by family and friends and 43% to residential care. Due to the impact of demographic ageing in the coming decades and the expected increase in the number of people with dementia, family caregivers and the general health and social care system will come under increasing pressure to provide adequate levels of care. Without a significant increase in the amount of resources devoted to dementia, it is unclear how the system will cope in the future. (Publisher abstract)
Conference proceedings: towards care management in Ireland: from the National Conference on Care Management in Health and Social Services for Older People, 21 November 2001, Dun Laoghaire
- Editors:
- QUILL Sinead, (ed.)
- Publisher:
- National Council on Ageing and Older People
- Publication year:
- 2002
- Pagination:
- 60p.
- Place of publication:
- Dublin
The Conference provided an opportunity to promote the benefits of Care Management in the context of a strategy for the provision of a continuum of care for older people. It also provided an opportunity to formulate good Care Management practices through the exchange of information on Care Management experiences, both nationally and internationally. The development of a draft Care Management Implementation Framework was also considered by participants.
Alzheimer's dementia in persons with Down's syndrome: predicting time spent on day-to-day caregiving
- Authors:
- McCARRON Mary, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 4(4), November 2005, pp.521-538.
- Publisher:
- Sage
The aim of this study was to investigate the amount of time formal caregivers spend addressing activities of day-to-day care activities for persons with Down's syndrome (DS) with and without Alzheimer's dementia (AD). Caregivers completed for 63 persons with DS and AD, and 61 persons with DS without AD, the Caregiving Activity Survey-Intellectual Disability (CAS-ID). Data was also gathered on co-morbid conditions. Regression analysis was used to understand predictors of increased time spent on day-to-day caregiving. Significant differences were found in average time spent in day-to-day caregiving for persons with and without AD. Mid-stage and end-stage AD, and co-morbid conditions were all found to predict increased time spent caregiving. Nature and tasks of day-to-day caregiving appeared to change as AD progressed. The study concluded that staff time to address day-to-day caregiving needs appeared to increase with onset of AD and did so most dramatically for persons with moderate intellectual disability. Equally, while the tasks for staff were different, time demands in caring for persons at both mid-and end-stage AD appeared similar.
Dementia and personhood: can social work help to re-discover the person?
- Authors:
- CAHILL Suzanne, HEADON Mary
- Journal article citation:
- Irish Social Worker, 12(1/2), Summer 2002, pp.13-16.
- Publisher:
- Irish Association of Social Workers
This article aims to: challenge dominant ideology abut dementia by dispelling some prevailing myths; provide Irish data on current and future prevalence rates of dementia; detail new cultures of care; explore the concept of personhood; and propose recommendations on the role of social work in helping to rediscover the individual with dementia.
Person-centred dementia care: a reality check in two nursing homes in Ireland
- Authors:
- COLOMER Jordi, de VRIES Jan
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 15(5), 2016, pp.1158-1170.
- Publisher:
- Sage
The introduction of a person-centred care (PCC) approach to dementia care has been a major paradigmatic shift in the care provision in residential settings for older adults in Ireland. However, policy implementation in nursing homes relies very much on the preparedness of nursing staff. This study explored this through semi-structured interviews with care assistants in two nursing homes which professed to support the PCC philosophy. The authors addressed their knowledge and perspectives of person-centred dementia care and views on various factors affecting its delivery. Findings showed considerable disparity between policy and practice, in particular because care assistants lacked clarity on what PCC is and reported that they were not educated in it. Notwithstanding this, carers’ perspectives on ‘good care’ for people with dementia included elements of PCC which suggested its ‘implicit’ use in practice. Besides the necessity of more (and more explicit) training on PCC, the findings also suggest concerns around communication between staff and management and the need for improvement of staffing resources and available time in residential settings in order to make the delivery of person-centred dementia care a reality. (Edited publisher abstract)
Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition
- Authors:
- TIMMONS Suzanne, et al
- Journal article citation:
- Age and Ageing, 44(6), 2015, pp.993-999.
- Publisher:
- Oxford University Press
Background: Previous studies have indicated a prevalence of dementia in older admissions of : p∼42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. Objective: To determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. Methods: Six hundred and six patients aged ≥70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. Results: Of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission. Conclusion: Dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital. (Publisher abstract)
Reminiscence in dementia: a concept analysis
- Authors:
- DEMPSEY Laura, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 13(2), 2014, pp.176-192.
- Publisher:
- Sage
This paper is a report of an analysis of the concept of reminiscence in dementia and highlights its uses as a therapeutic intervention used on individuals with dementia. No single definition of reminiscence exists in healthcare literature; however, definitions offered have similar components. The term life review is commonly used when discussing reminiscence; however, both terms are quite different in their goals, theory base and content. This concept analysis identified reminiscence as a process which occurs in stages, involving the recalling of early life events and interaction between individuals. The antecedents of reminiscence are age, life transitions, attention span, ability to recall, ability to vocalise and stressful situations. Reminiscence can lead to positive mental health, enhanced self esteem and improved communication skills. It also facilitates preparation for death, increases interaction between people, prepares for the future and evaluates a past life. Reminiscence therapy is used extensively in dementia care and evidence shows when used effectively it helps individuals retain a sense of self worth, identity and individuality. (Publisher abstract)
Loneliness and cognition in older people: the Dublin Healthy Ageing study
- Authors:
- O'LUANAIGH C., et al
- Journal article citation:
- Aging and Mental Health, 16(3), April 2012, pp.347-352.
- Publisher:
- Taylor and Francis
Several studies have shown that social isolation has a detrimental effect on cognition. However, relatively few have examined the relationship between cognition and loneliness. The aims of this study were to explore the relationship between loneliness and cognition, and to determine whether specific cognitive domains are associated with loneliness. The findings are taken from the Dublin Healthy Ageing Study, a prospective examination of the psychiatric, cognitive, physical and social well-being of community-dwelling elderly in inner-city Dublin. This study included 466 participants with mean age 75.45 years, of which 44% were males. Analyses were done of the relationship between loneliness, social networks, depression, and demographics, and global cognition. The main finding is that loneliness in older people is significantly associated with impaired global cognition independent of social networks and depression. The domains of psychomotor processing speed and delayed visual memory were specifically associated with self-reported loneliness. The mechanism for this association is unclear and warrants further investigation.
Guidelines for nursing homes delivering end-of-life care to residents with dementia across the island of Ireland
- Authors:
- CAHILL Suzanne, DORAN Daphne, WATSON Max
- Journal article citation:
- Quality in Ageing and Older Adults, 13(1), 2012, pp.60-70.
- Publisher:
- Emerald
This study investigated the experiences of elderly spouses whose relatives died with end-stage dementia in nursing homes in both Northern Ireland (NI) and the Republic of Ireland (RoI), with a view to improving quality of life for people with end stage dementia living in residential care settings. The study aimed to draft guidelines to a multi-disciplinary group of health service professionals for their critical appraisal and ratification. Results indicated that the care delivered was deemed by most elderly spouses to be of high quality, with person centred, individual, kind, professional care highly valued. Areas of dissatisfaction included poor communication, lack of involvement in key decision making, and poor symptoms control. Based on the study's findings, guidelines for the delivery of quality care in long stay residential institutions were developed in consultation with eight health service professionals.