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Are patients with dementia treated as well as patients without dementia for hypertension, diabetes, and hyperlipidaemia?
- Authors:
- MÜTHER Johannes, et al
- Journal article citation:
- British Journal of General Practice, 60(578), September 2010, pp.671-674.
- Publisher:
- Royal College of General Practitioners
This study investigated whether GPs treated patients with dementia differently than patients without it. The authors hypothesised that explanations for this could include stigmatisation, treatment with a palliative approach, and the result of the disease process. The index diseases of hypertension, diabetes, and hyperlipidaemia were used to measure care. Sixteen GP’s recruited all their patients with dementia and at least one of the index diseases. Patients without dementia but only the index diseases were matched for age, sex, index disease, and practice, resulting in 216 pairs of patients with and without dementia. Findings indicated no differences in treatment outcomes between the two patients groups, except one significant difference: one of the two documented systolic blood pressure values is lower in the dementia group. Furthermore, patients with dementia more often do not receive any medication or are treated with low-priced medications for hypertension. The authors concluded that GPs did not seem to treat patients with dementia differently, and the use of lower-priced antihypertensive medication could be the only indication for some kind of difference in approach.
Kvinder i klemme (Women in a cleft stick)
- Author:
- THESBJERG Grete
- Journal article citation:
- Nordisk Sosialt Arbeid, 4,, 1995, pp.243-257.
- Publisher:
- Universitetsforlaget AS
There are special expectations of women, especially of wives, to take on caring and nursing tasks when their husbands are suffering from senile dementia. Only a few receive proper diagnosis. The women slip unnoticed into the care task as the illness develops. The women's identity and role as housewife is threatened. They work on the basis of a mother/child model and are oppressed by a sense of powerlessness, insufficiency, and guilty conscience when the care does not have any results. The women are isolated. They give greater priority to the care task than to their own interests, and if the rest of the family and friends do not understand the situation, they stand alone with the task. The assistance offered by the public system is often quite insufficient. The result is two patients instead of one.
What is the relationship between people with dementia and their caregiver’s illness perceptions post-diagnosis and the impact on help-seeking behaviour? A systematic review
- Authors:
- GREGG Jane E, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 20(7), 2021, pp.2597-2617.
- Publisher:
- Sage
Background: As the number of people with dementia increases, more families will be affected by the daily challenges of providing effective support, given its current incurable status. Once individuals are diagnosed with dementia, the earlier they access support, the more effective the outcome. However, once people receive a diagnosis, how they make sense of their dementia can impact on their help-seeking intentions. Exploring the illness beliefs of people with dementia and their caregivers and this relationship to help seeking may identify how best to facilitate early support. Aims: To systematically obtain and critically review relevant studies on the relationship between illness perceptions and help seeking of people with dementia and their caregivers. Method: A systematic search was conducted and included both quantitative and qualitative studies. The initial search was conducted in October 2018, with an adjacent search conducted in April 2020. Findings: A total of 14 articles met the inclusion criteria. Conceptually, the studies examined the association of illness perceptions and help-seeking post-diagnosis and revealed that people living with dementia and their caregivers sought help when symptoms became severe. Components of illness perceptions revealed that lack of knowledge, cultural beliefs, complexity of the healthcare system, threat to independence and acceptance were identified as major factors for delaying help seeking. Conclusion: Although research interest in the area of illness perceptions and their impact on help seeking for dementia is increasing, further work is needed to understand this area, particularly regarding the influence of the relationship between the person with dementia and their caregiver. (Edited publisher abstract)
Illness representations in caregivers of people with dementia
- Authors:
- QUINN Catherine, JONES Ian Rees, CLARE Linda
- Journal article citation:
- Aging and Mental Health, 21(5), 2017, pp.553-561.
- Publisher:
- Taylor and Francis
Objectives: Illness representations shape responses to illness experienced by the self or by others. The illness representations held by family members of those with long-term conditions such as dementia influence their understanding of what is happening to the person and how they respond and provide support. The aim of this study is to explore components of illness representations (label, cause, control and timeline) in caregivers of people with dementia. Method: This was an exploratory study; the data reported came from the Memory Impairment and Dementia Awareness Study (MIDAS). Data from semi-structured interviews with 50 caregivers of people with dementia were analysed using content analysis. Results: The majority of caregivers gave accounts that appeared to endorse a medical/diagnostic label, although many used different terms interchangeably. Caregivers differentiated between direct causes and contributory factors, but the predominant explanation was that dementia had a biological cause. Other perceived causes were hereditary factors, ageing, lifestyle, life events and environmental factors. A limited number of caregivers were able to identify things that people with dementia could do to help manage the condition, while others thought nothing could be done. There were varying views about the efficacy of medication. In terms of timeline, there was considerable uncertainty about how dementia would progress over time. Conclusion: The extent of uncertainty about the cause, timeline and controllability of dementia indicated that caregivers need information on these areas. Tailored information and support taking account of caregivers' existing representations may be most beneficial. (Publisher abstract)
Serious illness in the over 50s
- Author:
- BEACH Brian
- Publisher:
- International Longevity Centre UK
- Publication year:
- 2015
- Pagination:
- 10
- Place of publication:
- London
Using data from the English Longitudinal Study of Ageing (ELSA), this briefing examines the prevalence of serious illness among people aged 50+ in the UK, focusing on Alzheimer's disease and other dementia, Parkinson's disease, cancer, heart attack, and stroke. The research suggests that whilst the number of older people with a serious illness will increase, improvements in health may actually result in a fall in the proportion of older people suffering one of the five conditions explored. ELSA data suggests that the prevalence of serious illness among those aged 50+ has been slightly decreasing over time, from 15.8 per cent in 2002 to 13.6 per cent in 2012. However, it also indicates that the overall prevalence of older people living with cancer shows a notable upward trend from 2002 to 2012 and that the prevalence of serious illness increased among those aged 80+, while declining dramatically for those in their 60s and 70s. (Edited publisher abstract)
Discharge diagnosis and comorbidity profile in hospitalized older patients with dementia
- Authors:
- ZULIANI Giovanni, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(3), March 2012, pp.313-320.
- Publisher:
- Wiley
Dementia is known to be present in a significant proportion of hospitalised older patients, and may be associated with different pathologies and longer stays in hospital. The aim of this study was to investigate the prevalence of dementia in a large sample of hospitalised older individuals, and to analyse principal discharge diagnosis and related comorbidity in the patients affected by dementia. Data from 51,838 consecutive computerised discharge records of individuals aged 60 years and over from a hospital in Ferrara, Italy were analysed. The number of admissions, length of stay in hospital, primary and secondary discharge diagnosis, number of procedures, and possible death were evaluated. The findings showed that demented patients represented 8.6% of the sample and were older and more likely to be female patients. They were characterised by higher number of admissions to hospital, instrumental clinical investigations, secondary diagnoses, and mortality rate. Among the primary diagnoses, a higher prevalence of cerebrovascular disease, pneumonia, and hip fracture was observed in demented patients. Furthermore, pulmonary embolism, renal failure, septicaemia, and urinary infections were frequently reported in demented patients, but not in controls. As regards secondary diagnoses, dementia was associated with an increased risk of delirium, muscular atrophy and immobilisation, dehydration, cystitis, and pressure ulcers, whereas the risk for other conditions, including cancer, was reduced.
Grandparenting in the 21st century: issues of diversity in grandparent–grandchild relationships
- Authors:
- STELLE Charlie, et al
- Journal article citation:
- Journal of Gerontological Social Work, 53(8), November 2010, pp.682-701.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Previous research has demonstrated the importance of age, ethnicity, and socioeconomic status in understanding grandparent–grandchild relationships; a relationship believed to be of value directly or indirectly to both parties. However the authors suggest that the value derived from this relationship may depend on a multiplicity of other factors. This article has three aims. First it presents an overview of the grandparent-grandchild relationship, focusing on factors that influence the connection. The authors then look at diversity among grandparents, with particular emphasis on gender, sexual orientation, and physical and/or cognitive limitations. They consider strength-based and empowerment strategies and their implications for practice, polices and future research. The article concludes that the diversity and context in which the relationship is embedded, and lifelong patterns of family experiences, exchange and attachment, must be considered in order to understand it. Although the review focussed on three subgroups of grandparents, it is suggested that other subgroups, such as those with mental illness, incarcerated grandparents and those in long term care also warrant study.
Prognosis is important in decisionmaking in Dutch nursing home patients with dementia and pneumonia
- Authors:
- van der STEEN Jenny, HELTON Margaret R., RIBBLE Miel W.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(9), September 2009, pp.933-936.
- Publisher:
- Wiley
This study explored how physicians treating nursing home residents with dementia and pneumonia in the Netherlands consider prognosis in their treatment decision. Survey study with data collected between July 2006 and March 2008. Physicians (n = 69) from 54 nursing homes in the Netherlands completed a questionnaire on symptoms, treatment, and prognosis for their next dementia patient newly diagnosed with pneumonia. They were also asked a general question regarding withholding antibiotic treatment and prognosis. Outcome was assessed at least two months afterwards. Two-week mortality risk if treated with antibiotics was calculated with a validated prognostic score. The patients not treated with antibiotics had high (92%) actual 2-week mortality while only 12% of patients treated with antibiotics died. Physicians believed that mortality risk was high in the untreated group and would have been only slightly lower if treated with antibiotics (mean estimated risk 73%), which was higher than predicted from the risk score (42%). In general, three-quarters of physicians considered withholding antibiotics appropriate for mortality risks between 75% and 90%. Prognosis is an important consideration when Dutch nursing home physicians make antibiotic treatment decisions for patients with dementia and pneumonia. This suggests they prefer not to treat with antibiotics when to do so is probably futile. Physicians in other countries may hold different views on futility, which should be addressed in larger, cross-national comparative studies.
Impact of hip fracture, heart failure and weight loss on the risk of institutionalization of community-dwelling patients with dementia
- Authors:
- HARBOUN Marc, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(12), December 2008, pp.1245-1252.
- Publisher:
- Wiley
This study sought to identify the influence of medical symptoms and diseases on the risk of nursing home placement in a prospective cohort of newly diagnosed community-dwelling patients with dementia. This French study included 348 patients with dementia, consecutively diagnosed, recruited and followed at a geriatric outpatient centre (mean age: 81 years, 65.5% with Alzheimer's disease, mean baseline MMSE score: 20.5, mean follow-up: 20.5 months). After adjustment for factors commonly associated with institutionalization in this population, hip fracture in the 3 years preceding diagnosis, acute congestive heart failure during follow-up and weight loss of more than 5% in any year during follow-up were independently associated with nursing home placement. This study confirms the independent contribution of specific medical symptoms and diseases to earlier institutionalization of patients with dementia. These results stress the importance of better knowledge of the specific characteristics of hip fracture, weight loss and congestive heart failure in the context of dementia, to make more effective prevention possible in this patient population.
An ethnographic study of stigma and ageism in residential care or assisted living
- Authors:
- DOBBS Debra, et al
- Journal article citation:
- Gerontologist, 48(4), August 2008, pp.517-526.
- Publisher:
- Oxford University Press
Ethnography and other qualitative data-gathering and analytic techniques were used to gather data from 309 participants (residents, family and staff) from six residential care or assisted living (RC–AL) settings in Maryland. Transcript data was then entered into Atlas.ti 5.0 and analyzed using grounded theory techniques for emergent themes. Four themes emerged that relate to stigma in RC–AL: (a) ageism in long-term care; (b) stigma as related to disease and illness; (c) sociocultural aspects of stigma; and (d) RC–AL as a stigmatizing setting. Some strategies used in RC–AL settings to combat stigma include family member advocacy on behalf of stigmatized residents, assertion of resident autonomy, and administrator awareness of potential stigmatization. Findings suggest that changes could be made to the structure as well as the process of care delivery to minimize the occurrence of stigma in RC–AL settings. Structural changes include an examination of how best, given the resident case mix, to accommodate care for persons with dementia (e.g., separate units or integrated care); processes of care include staff recognition of resident preferences and strengths, rather than their limitations.