scholarly journals Perspectives of healthcare professionals in England on falls interventions for people with dementia: a qualitative interview study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e025702 ◽  
Author(s):  
Clare Burgon ◽  
Janet Darby ◽  
Kristian Pollock ◽  
Veronika van der Wardt ◽  
Tamsin Peach ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Falls Prevention ◽  
Future Research ◽  
Visual Aids ◽  
Exercise Interventions ◽  
Memory Assessment ◽  
People With Dementia ◽  
East Midlands ◽  
Qualitative Interview Study ◽  
The Individual

ObjectiveTo explore the experiences of healthcare professionals working in falls prevention and memory assessment services in providing assessments and interventions for falls risk reduction in people with dementia.DesignThis is a qualitative study using 19 semistructured interviews. Interviews were analysed through thematic analysis.SettingCommunity-based falls and memory assessment services in the East Midlands, UK.ParticipantsNurses (n=10), physiotherapists (n=5), occupational therapists (n=3) and a psychiatrist (n=1).ResultsThree substantive themes were identified: challenges posed by dementia, adaptations to make falls prevention appropriate for people with dementia and organisational barriers. Patients’ poor recall, planning and increased behavioural risk associated with dementia were key problems. Healthcare professionals provided many suggestions on how to overcome these challenges, such as adapting exercise interventions by using more visual aids. Problems associated with cognitive impairment created a need for additional support, for instance longer interventions, and supervision by support workers, to enable effective intervention, yet limited resources meant this was not always achievable. Communication between mental and physical health teams could be ineffective, as services were organised as separate entities, creating a reliance on third parties to be intermediaries. Structural and organisational factors made it difficult to deliver optimal falls prevention for people living with dementia.ConclusionsHealthcare professionals experience challenges in providing falls prevention to people with dementia at the individual and organisational levels. Interventions can be adapted for people with dementia, but this requires additional resources and improved integration of services. Future research is needed to develop and test the effectiveness and cost-effectiveness of such services.

scholarly journals Gender Perspective on Older People’s Exercise Preferences and Motivators in the Context of Falls Prevention: A Qualitative Study

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Marlene Sandlund ◽  
Petra Pohl ◽  
Christina Ahlgren ◽  
Dawn A. Skelton ◽  
Anita Melander-Wikman ◽  
...  
Keyword(s):  
Fall Prevention ◽  
Qualitative Content Analysis ◽  
Exercise Adherence ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Gender Perspective ◽  
Exercise Interventions ◽  
History Of ◽  
Exercise Programmes ◽  
The Individual

Background. Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises. Aim. To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective. Methods. Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. Results. Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men. Conclusion. Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women’s and men’s preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.

Non-pharmacological interventions in care homes, with particular emphasis on the treatment of people with dementia

2020 ◽  
pp. 265-280
Author(s):  
Ian A. James ◽  
Alan Howarth
Keyword(s):  
Psychosocial Interventions ◽  
Care Homes ◽  
Future Research ◽  
Pharmacological Interventions ◽  
Cognitive Health ◽  
Care Plans ◽  
People With Dementia ◽  
The Individual ◽  
The Uk ◽  
Preventative Interventions

In the UK there are over 22,000 care homes, largely run by the private and charitable sectors, caring for 416,000 people. The residents in care homes present with a range of needs linked to physical health, cognitive health, and mental health. A large proportion of residents in care homes have dementia and many of them exhibit Behaviours that Challenge (BtC). This chapter focuses on the non-pharmacological interventions available in care homes to help treat BtC that occur in the context of dementia. It discusses preventative interventions designed to promote the wellbeing of people with dementia, and reviews the evidence. Formulation-led interventions identify the needs of the individual and lead to the development of person-centred care plans and the evidence strongly supports that these are needed to deliver effective psychosocial interventions in care homes. Finally, the chapter discusses the implications for future research.

Advance care planning in different settings for people with dementia: A systematic review and narrative synthesis

2019 ◽  
Vol 17 (6) ◽  
pp. 707-719 ◽  
Author(s):  
Adele J. Kelly ◽  
Tim Luckett ◽  
Josephine M. Clayton ◽  
Liam Gabb ◽  
Slavica Kochovska ◽  
...  
Keyword(s):  
Systematic Review ◽  
Advance Care Planning ◽  
Future Research ◽  
Care Planning ◽  
People With Dementia ◽  
Future Care ◽  
Advance Care ◽  
Surrogate Decision ◽  
The Individual ◽  
Person With Dementia

AbstractBackgroundAdvance care planning (ACP) is identified as being an important process for people with dementia. However, its efficacy for improving outcomes relevant for the individual, carers and the health system has yet to be established.AimWe conducted a systematic review with the aims of testing the efficacy of ACP for people with dementia and describing the settings and population in which it has been evaluated.MethodsA search was completed of electronic databases in August 2016. Articles were included if they described interventions aimed at increasing planning for future care of people with dementia, delivered to the person with dementia, their carers and/or health professionals.ResultsOf 4,772 articles returned by searches, 30 met the inclusion criteria, testing interventions in nursing home (n= 16) community (n = 10) and acute care (n = 4) settings. Only 18 interventions directly involved the person with dementia, with the remainder focusing on surrogate decision-makers. In all settings, interventions were found effective in increasing ACP practice. In nursing homes, ACP was found to influence care and increase the concordance between end of life wishes and care provided. Interventions in the community were found to improve patient quality of life but were not shown to influence concordance.ConclusionFuture research should focus on ways to involve people with dementia in decision-making through supported means.

A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia

2016 ◽  
Vol 29 (1) ◽  
pp. 81-91 ◽  
Author(s):  
Morag E. Taylor ◽  
Stephen R. Lord ◽  
Henry Brodaty ◽  
Susan E. Kurrle ◽  
Sarah Hamilton ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older People ◽  
Exercise Program ◽  
Community Dwelling ◽  
Future Research ◽  
Exercise Interventions ◽  
People With Dementia ◽  
Home Based ◽  
Increased Risk ◽  
Community Dwelling Older People

ABSTRACTBackground:Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia.Methods:Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial.Results:Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to <70% of sessions.Conclusions:This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.

scholarly journals ‘A Safe Place Where I Am Welcome to Unwind When I Choose to’—Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study

2021 ◽  
Vol 19 (1) ◽  
pp. 300
Author(s):  
Rose-Marie Lindkvist ◽  
Sofie Westling ◽  
Sophia Eberhard ◽  
Björn Axel Johansson ◽  
Olof Rask ◽  
...  
Keyword(s):  
At Risk ◽  
Target Group ◽  
Future Research ◽  
Negative Effects ◽  
Safe Place ◽  
Safe Environment ◽  
Management Intervention ◽  
Qualitative Interview Study ◽  
Self Harm ◽  
The Individual

Evidence is lacking on how to manage imminent suicidality in adolescents with self-harm. Brief Admission by Self-referral (BA) is a crisis-management intervention, developed for adults with self-harm at risk for suicide. Structured, individualized and based on responsible autonomy, BA aims to provide a respite while minimizing negative effects of hospitalization. This qualitative interview study illuminates adolescents’ experiences of BA, adapted for this target group. Nineteen adolescents aged 14 to 19 years, described BA as helpful for timely rest and recovery to save themselves from impulses to self-harm. The individual contract, which is a prerequisite for access to BA, was perceived to give access to professional support in a safe environment, also among adolescents not using their contract. Being trusted with responsibility to self-admit was also hard work with struggles of self-doubt. Challenges included experiencing distrust from staff and fear of not being able to abstain from self-harm, which BA is conditioned upon. However, this condition was also perceived to induce self-motivation and growth. BA appeared well-adapted to the target group, fulfilling needs of predictability, autonomy, and opportunity for recovery to prevent self-harm. Suggestions for improvement included continually informing staff about important features of BA. To further evaluate benefits and challenges of BA, future research may evaluate clinical and health-economic outcomes and perspectives from parents and caregivers.

scholarly journals The second-hand effects of antibiotics: communicating the public health risks of drug resistance

2019 ◽  
Vol 1 (3) ◽  
Author(s):  
B J Langford ◽  
N Daneman ◽  
V Leung ◽  
J H C Wu ◽  
K Brown ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Antibiotic Use ◽  
Modern Medicine ◽  
Future Research ◽  
Term Care ◽  
Patient Counselling ◽  
The Public ◽  
Fuel Demand ◽  
The Individual

Abstract Antimicrobial resistance (AMR) poses a threat to modern medicine, but there are challenges in communicating its urgency and scope and potential solutions to this growing problem. It is recognized that AMR has a ‘language problem’ and the way in which healthcare professionals communicate about AMR may not always resonate with patients. Many patients are unaware that antibiotics can have detrimental effects to those beyond the recipient, due to transmission of drug-resistant organisms. The overestimation of benefits and underestimation of risks helps to fuel demand for antibiotic use in situations where they may be of little or no benefit. To better communicate risks, clinicians may borrow the term ‘second-hand’ from efforts to reduce smoking cessation. We present several examples where antibiotics themselves have second-hand effects beyond the individual recipient in hospitals, long-term care homes and the community. Incorporation of the concept of the second-hand effects of antibiotics into patient counselling, mass messaging and future research may help facilitate a more balanced discussion about the benefits and risks of antibiotic use in order to use these agents more appropriately.

Development of a German-Language Questionnaire to Measure Collective Orientation as an Individual Attitude

2017 ◽  
Vol 76 (3) ◽  
pp. 91-105 ◽  
Author(s):  
Vera Hagemann
Keyword(s):  
Team Performance ◽  
Reliability And Validity ◽  
Future Research ◽  
German Language ◽  
Team Members ◽  
Collective Orientation ◽  
Team Research ◽  
German Speaking ◽  
Individual Variables ◽  
The Individual

Abstract. The individual attitudes of every single team member are important for team performance. Studies show that each team member’s collective orientation – that is, propensity to work in a collective manner in team settings – enhances the team’s interdependent teamwork. In the German-speaking countries, there was previously no instrument to measure collective orientation. So, I developed and validated a German-language instrument to measure collective orientation. In three studies (N = 1028), I tested the validity of the instrument in terms of its internal structure and relationships with other variables. The results confirm the reliability and validity of the instrument. The instrument also predicts team performance in terms of interdependent teamwork. I discuss differences in established individual variables in team research and the role of collective orientation in teams. In future research, the instrument can be applied to diagnose teamwork deficiencies and evaluate interventions for developing team members’ collective orientation.

Cancer treatment decisions for people living with dementia: experiences of family carers

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711545
Author(s):  
Catherine Hynes ◽  
Caroline Mitchell ◽  
Lynda Wyld
Keyword(s):  
Cancer Treatment ◽  
Healthcare Professionals ◽  
Cancer Recurrence ◽  
Treatment Decisions ◽  
Support Needs ◽  
Family Carers ◽  
Structured Interviews ◽  
Power Of Attorney ◽  
Cancer Data ◽  
People With Dementia

BackgroundDementia and cancer are both diseases associated with older age. The National Cancer Data Audit in England found that 4.4% of people diagnosed with cancer also had cognitive impairment. Decisions about cancer treatment can be very complex when someone already has dementia. Often someone’s closest relative may be asked to make decisions on their behalf. Little is known about the psychosocial impact that this has on carers, or what their support needs are during this time.AimTo explore the experiences of family carers who have been involved in making cancer treatment decisions on behalf of a relative with dementia, in particular identifying challenges and support needs.MethodThe authors are conducting semi-structured interviews with carers of people with dementia who have been involved in making decisions about cancer treatment on their behalf. Data is being thematically analysed using an inductive approach. Two researchers will independently verify themes.ResultsThe authors expect to have completed 14–18 interviews and will report their preliminary findings. Family carers experience many difficulties in the context of cancer and dementia, including lack of support when coping with the aftereffects of cancer treatment, lack of awareness among healthcare professionals regarding the authority granted by a lasting power of attorney and the anxiety created by feeling responsible for identifying cancer recurrence.ConclusionThis study will highlight that supporting someone with dementia through cancer treatment, and having to make decisions about it on their behalf, creates unique challenges for carers. Currently there is a significant lack of support for those facing this distressing experience.

Academic Events: An Empirically Grounded Typology and Their Academic Impact

2020 ◽  
Vol 24 (4) ◽  
pp. 481-497 ◽  
Author(s):  
Thomas Trøst Hansen ◽  
David Budtz Pedersen ◽  
Carmel Foley
Keyword(s):  
Analytical Framework ◽  
Future Research ◽  
Academic Impact ◽  
Future Research Agenda ◽  
Tourism Studies ◽  
Academic Events ◽  
Business Events ◽  
The Individual ◽  
Analytical Frameworks ◽  
Academic Sector

The meetings industry, government bodies, and scholars within tourism studies have identified the need to understand the broader impact of business events. To succeed in this endeavor, we consider it necessary to develop analytical frameworks that are sensitive to the particularities of the analyzed event, sector, and stakeholder group. In this article we focus on the academic sector and offer two connected analyses. First is an empirically grounded typology of academic events. We identify four differentiating dimensions of academic events: size, academic focus, participants, and tradition, and based on these dimensions we develop a typology of academic events that includes: congress, specialty conference, symposium, and practitioners' meeting. Secondly, we outline the academic impact of attending these four types of events. For this purpose, the concept of credibility cycles is used as an analytical framework for examining academic impact. We suggest that academic events should be conceptualized and evaluated as open marketplaces that facilitate conversion of credibility. Data were obtained from interviews with 22 researchers at three Danish universities. The study concludes that there are significant differences between the events in terms of their academic impact. Moreover, the outcome for the individual scholar depends on the investment being made. Finally, the study calls for a future research agenda on beyond tourism benefits based on interdisciplinary collaborations.

Physiology of Larval Feeding

2018 ◽  
Keyword(s):  
Growth And Development ◽  
Marine Invertebrate ◽  
Larval Growth ◽  
Circulatory System ◽  
Future Research ◽  
Larval Feeding ◽  
Digestive Physiology ◽  
Larval Body ◽  
The Individual ◽  
Invertebrate Larvae

The functional properties of marine invertebrate larvae represent the sum of the physiological activities of the individual, the interdependence among cells making up the whole, and the correct positioning of cells within the larval body. This chapter examines physiological aspects of nutrient acquisition, digestion, assimilation, and distribution within invertebrate larvae from an organismic and comparative perspective. Growth and development of larvae obviously require the acquisition of “food.” Yet the mechanisms where particulate or dissolved organic materials are converted into biomass and promote development of larvae differ and are variably known among groups. Differences in the physiology of the digestive system (secreted enzymes, gut transit time, and assimilation) within and among feeding larvae suggest the possibility of an underappreciated plasticity of digestive physiology. How the ingestion of seawater by and the existence of a circulatory system within larvae contribute to larval growth and development represent important topics for future research.

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