scholarly journals 320 - Barriers to Deprescribing in Older Adults with Dementia

2020 ◽  
Vol 32 (S1) ◽  
pp. 78-78
Author(s):  
Mariana Duarte-Mangas ◽  
Gonçalo A. Santos ◽  
Beatriz Jorge ◽  
Catarina Pedro Fernandes
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Chronic Illnesses ◽  
Negative Consequences ◽  
Inappropriate Drugs ◽  
People With Dementia ◽  
Decision Making Capacity ◽  
Multiple Morbidities ◽  
Over Time

Individuals with dementia usually have multiple chronic illnesses, most of whom are medicated with five or more medications. However, as dementia progresses and the goal of care moves from prolonging life to optimizing quality of life, the risk of taking certain medications may outweigh its benefit. Therefore, it is necessary to reassess the medication over time.The objective of this work was to explore the barriers to optimising prescribing and deprescribing (withdrawing) of medications and the benefits of this procedure. Optimizing pharmacological treatment for people with dementia usually requires the prescription of inappropriate drugs and the initiation of other drugs. Several obstacles to the optimization of treatment have been identified in elderly people with multiple morbidities, related to the doctor, the health system, the patient and the caregiver, including: inadequate guidelines, incomplete medical history, prevention of negative consequences and established beliefs in the benefits and harms medication. Desprescribing older people with dementia is made even more difficult by the decrease in decision-making capacity, difficulties in understanding and communicating, increased involvement of caregivers and difficulties in setting goals.

Relation Between Quality of Life and Chronic Illnesses in Elderly Living in Residential Homes: A Prospective Study

1999 ◽  
Vol 11 (4) ◽  
pp. 445-454 ◽  
Author(s):  
Pim Cuijpers ◽  
Paula van Lammeren ◽  
Bernadette Duzijn
Keyword(s):  
Quality Of Life ◽  
Bodily Pain ◽  
Chronic Illnesses ◽  
Health Perceptions ◽  
Residential Homes ◽  
Related Quality ◽  
Health Related ◽  
A Prospective Study ◽  
Over Time

Health-related quality of life (HRQL) was investigated in 211 inhabitants of five residential homes in The Netherlands and was assessed again 1 year later. It was examined (a) if HRQL was related to the presence of specific general medical illnesses, (b) if comorbidity resulted in poorer HRQL, independent of the type of illness, and (c) if HRQL remained stable over time (1 year). We found that the illnesses we investigated contributed only little power to the prediction of HRQL, although some coefficients were significant. Comorbidity was also found to be a significant predictor of several aspects of HRQL, but did not contribute much power either. Several aspects of HRQL (bodily pain, health perceptions, and social functioning) remained stable over time, whereas other aspects (role functioning, activities of daily living) deteriorated. There was a trend indicating that mental health improves over time. Improvement and deterioration on aspects of HRQL were relatively strongly related to the scores on these aspects 1 year earlier, but not to specific illnesses or comorbidity.

scholarly journals Monitoring changes in the organization of Dutch long-term care and their effects on the mental health and wellbeing of people with dementia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
H van der Roest ◽  
M Prins ◽  
J van Erp ◽  
E Hartstra ◽  
A van der Schot
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Nursing Homes ◽  
Long Term Care ◽  
Behavioral Symptoms ◽  
Term Care ◽  
People With Dementia ◽  
Over Time

Abstract Background The 'Living Arrangements for People with Dementia (LAFD)' monitor-study aims to provide insight into effects of changes in the organization of Dutch long-term care for people with dementia. The objective of this study is to evaluate changes over time in the level of cognitive impairment, the frequency and severity of behavioral symptoms, and quality of life of residents with dementia, and changes in staffing levels. The study allows for detection of trends and developments that are relevant for the quality of nursing home care. Methods The LAFD-study is a repeated cross-sectional study. Since 2008, assessments have been conducted in participating nursing homes every two year. Up to 2020, five assessments have been completed. The number of participating nursing homes over time ranged from 47 to 144 and a sample of one third of residents was included in the study. Data collection was performed by care professionals. Cognitive impairment was assessed with the Cognitive Performance Scale, frequency and severity of behavioral symptoms were assessed with the Neuropsychiatric Inventory; quality of life was assessed with de Qualidem. Per nursing home, the amount of direct provided care was inventoried. Results Assessments up to 2017/2018 showed an improvement in cognitive functioning and quality of life in Dutch nursing homes. The amount of behavioral problems did not change, as did the amount of direct care. However, the level of professional caregivers increased slightly. In the last assessment, 53 nursing homes participated, and 668 residents were included. The fast majority of participants was over 80 years of age (67.1%) and 68.5% were female. The data are currently being further analyzed and presented at the conference. Conclusions There is a trend of improvement in cognitive functioning and quality of life up to 2018. The most recent assessment will indicate whether these positive trends continue.

Deferred Decision Making: patients’ reliance on family and physicians for cpr decisions in critical care

2005 ◽  
Vol 12 (5) ◽  
pp. 493-506 ◽  
Author(s):  
Su Hyun Kim ◽  
Diane Kjervik
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Odds Ratio ◽  
Daily Living ◽  
Psychological Variables ◽  
Factors Associated ◽  
Decision Making Capacity ◽  
Seriously Ill Patients ◽  
Seriously Ill

The aim of this study was to investigate factors associated with seriously ill patients’ preferences for their family and physicians making resuscitation decisions on their behalf. Using SUPPORT II data, the study revealed that, among 362 seriously ill patients who were experiencing pain, 277 (77%) answered that they would want their family and physicians to make resuscitation decisions for them instead of their own wishes being followed if they were to lose decision-making capacity. Even after controlling for other variables, patients who preferred the option of undergoing cardiopulmonary resuscitation (CPR) in the future were twice as likely, and those who had had ventilator treatment were four-fifths less likely, to rely on their family and physicians than those who did not want CPR (odds ratio (OR)-2.28; 95% confidence interval (CI) 1.18-4.38) or those who had not received ventilator treatment (OR-0.23; 95% CI 0.06-0.90). Psychological variables (anxiety, quality of life, and depression), symptomatic variables (severity of pain and activities of daily living) and the existence of surrogates were not significantly associated with patients’ preferences for having their family and physicians make resuscitation decisions for them. Age was not a significant factor for predicting the decision-making role after controlling for other variables.

A qualitative exploration of family carer’s understandings of people with dementia’s expectations for the future

Dementia ◽  
2020 ◽  
pp. 147130122092954
Author(s):  
Sheridan T Read ◽  
Christine Toye ◽  
Dianne Wynaden
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Family Carers ◽  
Structured Interviews ◽  
Grounded Theory Method ◽  
People With Dementia ◽  
Care Partners ◽  
The Future ◽  
Constant Comparative Analysis

Background There is little evidence that outlines how family carers understand the person with dementia’s perspective, values and anticipated future needs. Whilst people with dementia should be consulted about their own quality of life and care values, carers – otherwise known as care partners – require such understandings to ensure that the support the person receives into the future upholds their quality of life and is consistent with what they desire. Aim This research aimed to explore and describe family carers’ experience of supporting the person with dementia to maintain their quality of life by understanding how carers developed an awareness and understanding of the person with dementia’s expectations for the future and what they believed was important for the person to whom they provided care. Method Using an application of the grounded theory method, data were collected from 21 carers during semi structured interviews and analysed using constant comparative analysis. Findings Four categories emerged from the data: Knowing the person, Process of decision making, Maintaining normalcy and quality of life and Out of their control. Discussion This study provides insights into how carers developed awareness of the expectations of people with dementia. Findings also illuminate carers’ perspectives of the changing nature of decision making during the dementia trajectory. Conclusion Understanding the perspective of the person living with dementia is essential to facilitate advocacy and support that is ‘person centred’ now and into the future. Assisting carers to incorporate this perspective into caring has the potential to be better facilitated by health professionals and merits further investigation.

scholarly journals A Randomized Controlled Trial Exploring the Effect of Music on Quality of Life and Depression in Older People with Dementia

2010 ◽  
Vol 15 (5) ◽  
pp. 765-776 ◽  
Author(s):  
Marie Cooke ◽  
Wendy Moyle ◽  
David Shum ◽  
Scott Harrison ◽  
Jenny Murfield
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Depressive Symptoms ◽  
Older People ◽  
Controlled Trial ◽  
Self Esteem ◽  
Randomized Controlled ◽  
People With Dementia ◽  
Over Time

This randomized controlled trial investigated the effect of live music on quality of life and depression in 47 older people with dementia using the Dementia Quality of Life and Geriatric Depression Scale. The control/reading group reported higher mid-point feelings of belonging than the music group ( F(1, 45) = 6.672, p < .05). Sub-analyses of ≥ 50 per cent music session attendance found improvements in self-esteem over time ( F(2, 46) = 4.471, p < .05). Participants with scores that were suggestive of increased depressive symptoms had fewer depressive symptoms over time ( F(2, 22) = 8.129, p < .01). Findings suggest music and reading activities can improve self-esteem, belonging and depression in some older people with dementia.

scholarly journals Compulsory Interventions in Severe and Persistent Mental Illness: A Survey on Attitudes Among Psychiatrists in Switzerland

2021 ◽  
Vol 12 ◽  
Author(s):  
Julia Stoll ◽  
Martina A. Hodel ◽  
Florian Riese ◽  
Scott A. Irwin ◽  
Paul Hoff ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Mental Illness ◽  
Anorexia Nervosa ◽  
Cross Sectional Survey ◽  
Persistent Mental Illness ◽  
Decision Making Capacity ◽  
Case Vignettes ◽  
Persistent Depression

Background: Some psychiatric patients develop severe and persistent mental illness (SPMI), which, for a variety of reasons, can be therapy-refractory. Sometimes, treatment is not considered helpful by the patients themselves and does not improve their subjective quality of life. Furthermore, many SPMI patients experience compulsory interventions such as seclusion, restraint, or treatment against their will, which can cause harm.Methods: In a cross-sectional survey of 1,311 German-speaking psychiatrists in Switzerland, participants were asked about the care of SPMI patients in general, and about their attitudes with regard to compulsory interventions in particular, using three case vignettes of patients with severe and persistent anorexia nervosa, schizophrenia and depression.Results: Out of 1,311 contacted psychiatrists, 457 (34.9%) returned the completed survey. In general, 91.0% found it important or very important to respect SPMI patients' autonomy in decision making. However, based on three different clinical case vignettes, 36.8% of psychiatrists would act against the wishes of the patient with severe and persistent schizophrenia, 34.1% against the wishes of the patient with severe and persistent depression, and 21.1% against the wishes of the patient with severe and persistent anorexia nervosa, although all patients were stated to have preserved decision-making capacity. With regard to the case vignettes, 41.1% considered compulsory interventions leading to a temporary reduction of quality of life acceptable in the patient with severe and persistent schizophrenia, 39.4% in the patient with severe and persistent depression, and 25.6% in the patient with severe and persistent anorexia nervosa, although it was stated in all three case vignettes that two independent experts ascribed the patients decision-making capacity regarding their illness and further treatment.Conclusions: Many psychiatrists in our sample found themselves in an ethical dilemma between autonomy and the provision of medical care. While most respondents respect the autonomy of SPMI patients, many saw the need to perform compulsory interventions even though it was clearly and prominently stated that two independent psychiatrists had ascribed the patients in the case vignettes decision-making capacity. Further examination of these conflicting views is warranted, perhaps along with the development of guidelines for such situations.

scholarly journals The anthropic risks, climate change and coronavirus pandemic (COVID-19)

2021 ◽  
Vol 2 ◽  
Author(s):  
Carmen Gonçalves ◽  
Orfeu Bertolami
Keyword(s):  
Climate Change ◽  
Quality Of Life ◽  
Decision Making ◽  
Human History ◽  
Decision Making Capacity ◽  
Acceptable Risks ◽  
Resilient Communities ◽  
The Veil ◽  
The Impact

Risks have always been present throughout human history, however, today are qualitatively different, as many of them are anthropic (human-made). The fact that people are exposed to dangers for which they have no decision-making capacity depended on knowledge they often do not have in order to decide on possible acceptable risks. The pandemic situation we face now brings light on human-made risks; came and lifted the veil, if there were any doubts, about the impact on the quality of life on the Planet, as consequence of human decisions and behaviour. Two types of human-made risks will be addressed: climate change and the pandemic caused by the coronavirus (SARS-CoV-2); reflecting on the exposure of structural vulnerabilities, these risks bring forth the importance of social capital and social networks in reducing vulnerabilities, the investment in science and its dissemination, and prevention, as preparedness for future risks, promoting resilience. Thus, governance relationships between States, economic models and resilient communities will also be addressed.

Dementia-specific quality of life instruments: a conceptual analysis

2016 ◽  
Vol 28 (8) ◽  
pp. 1245-1262 ◽  
Author(s):  
P. Missotten ◽  
G. Dupuis ◽  
S. Adam
Keyword(s):  
Quality Of Life ◽  
Conceptual Analysis ◽  
Conceptual Frameworks ◽  
The Past ◽  
People With Dementia ◽  
Health Related Qol ◽  
Health Related ◽  
Quality Of Life Instruments ◽  
Over Time

ABSTRACTBackground:Over the past 20 years, many researchers have worked in developing various methods for measuring quality of life (QoL) of people with dementia. The aim of this review is to develop the conceptual frameworks of the dementia-specific QoL instruments, to identify their evolution over time and to provide elements of reflection on the QoL concept in dementia and its evaluation.Methods:An electronic search was conducted on PsycINFO and MEDLINE databases, from January 1985 to June 2015 using a combination of key words that include QoL, dementia, and review.Results:The analysis of the conceptual frameworks of the 18 selected dementia-specific QoL tools shows a great diversity in: (1) the QoL definitions (e.g. health-related QoL definitions, QoL definitions based on Lawton's work, or similar to this latter); (2) the theoretical QoL models (e.g. Lawton’ work and modified Lawton, adaptation, personhood); (3) the domains and dimensions; (4) the way to construct the instrument (e.g. development based on literature, opinion of the experts), and (5) the items’ formulation (e.g. use of criterion of intensity or frequency).Conclusions:There are different conceptual frameworks in the dementia-specific QoL measures with improvements over time (e.g. inclusion of interesting concepts such as adaptation, taking into account the views of patients themselves). Each of the conceptual parameters (definitions, models, domains, and dimensions) is discussed to identify the scales that are conceptually the strongest. Through their review, recommendations for future instrument refinement and development are discussed and a new QoL definition is proposed.

Perceived Overprotection and Its Association With Quality of Life in Dementia

GeroPsych ◽  
2019 ◽  
Vol 32 (3) ◽  
pp. 125-134
Author(s):  
Mechthild Niemann-Mirmehdi ◽  
Andreas Häusler ◽  
Paul Gellert ◽  
Johanna Nordheim
Keyword(s):  
Quality Of Life ◽  
Patient Autonomy ◽  
Positive Association ◽  
Well Being ◽  
Negative Association ◽  
Significant Positive Association ◽  
Cross Sectional ◽  
People With Dementia ◽  
Mental Well Being

Abstract. To date, few studies have focused on perceived overprotection from the perspective of people with dementia (PwD). In the present examination, the association of perceived overprotection in PwD is examined as an autonomy-restricting factor and thus negative for their mental well-being. Cross-sectional data from the prospective DYADEM study of 82 patient/partner dyads (mean age = 74.26) were used to investigate the association between overprotection, perceived stress, depression, and quality of life (QoL). The analyses show that an overprotective contact style with PwD has a significant positive association with stress and depression, and has a negative association with QoL. The results emphasize the importance of avoiding an overprotective care style and supporting patient autonomy.

Sign in / Sign up

Export Citation Format

Share Document