Unmet needs of family caregivers of hospitalized older adults preparing for discharge home

2018 ◽  
Vol 16 (2) ◽  
pp. 131-145 ◽  
Author(s):  
Jane McCusker ◽  
Mark Yaffe ◽  
Sylvie D Lambert ◽  
Martin Cole ◽  
Manon de Raad ◽  
...  
Keyword(s):  
Older Adults ◽  
Family Caregivers ◽  
Medical Information ◽  
Unmet Needs ◽  
Depression Scale ◽  
Principal Component ◽  
Care Hospital ◽  
Role Clarity ◽  
High Burden ◽  
Hospitalized Older Adults

Objectives To describe unmet needs of caregivers of hospitalized older adults during the transition from hospital back home, and identify subgroups with different needs. Methods Patients and family caregivers were recruited from an acute care hospital in Montreal, Canada. Measures included Instrumental Activities of Daily Living (IADL), Hospital Anxiety and Depression Scale (HADS), Zarit burden scale, and Family Inventory of Needs. Dimensions of unmet needs were explored with principal component analysis; regression tree models were used to identify subgroups with different unmet needs. Results A total of 146 patient-caregiver dyads were recruited. Three categories of caregiver unmet needs were identified: patient medical information; role clarity and support; and reassurance. Caregiver subgroups with highest unmet needs were those with high burden of care plus depressive symptoms ( n = 46) and those caring for patients with low IADL scores ( n = 10). Discussion Caregivers with high burden and depression are those with the greatest unmet needs during the care transition.

scholarly journals 411 - Implementing the STrAtegies for RelaTives (START) intervention in Portugal – preliminary findings

2020 ◽  
Vol 32 (S1) ◽  
pp. 127-127
Author(s):  
Fatima Urzal ◽  
Ana Quintão ◽  
Catarina Santos ◽  
Nuno Moura ◽  
Ana Banazol ◽  
...  
Keyword(s):  
Pilot Study ◽  
Coping Strategies ◽  
Family Caregivers ◽  
Clinical Training ◽  
Unmet Needs ◽  
Depression Scale ◽  
Subjective Impression ◽  
Implementation Challenges ◽  
People With Dementia ◽  
The Uk

IntroductionAs in other countries, Portuguese family caregivers have unmet needs regarding information and distress. START (STrAtegies for RelaTives) is a manual-based coping intervention for families of people with dementia, including coping strategies and stress-management components, by Livingston and colleagues (https://www.ucl.ac.uk/psychiatry/research/mental-health-older-people/projects/start). In the UK, START has been clinically effective, immediately and continuing even after 6-years, without increasing costs. Clinical training and supervision ensures treatment fidelity. In Portugal, these kind of interventions are less available and, when provided, are mostly supportive and fail to address coping strategies. Paradoxically, recruitment may also prove challenging.ObjectivesWe describe the development of the Portuguese translation of START, incorporating guidance from the UK team, and a pilot study of delivery to family caregivers of people with dementia. We will also discuss the challenges of recruiting participants and delivering the intervention.MethodWe translated the START intervention and recruited family caregivers from neurology and psychiatry outpatients, in a central hospital in Lisbon. Our baseline assessment included the Hospital Anxiety and Depression Scale and the Zarit Burden Interview. The pilot is still ongoing at time of submitting, so we focus on recruitment, baseline assessments and process issues.ResultsDuring a three-month period, we recruited six caregivers. Five were primary caregivers (spouses or adult children) who had been caring for their relatives for 2 up to 10 years. Two caregivers met the international cutoff for clinically relevant affective disorder . The most frequent motivators for taking part were learning to communicate with their relatives and increasing knowledge to build community resources. Overall, the subjective impression of the therapist in charge is that the intervention seems acceptable and promising.Discussion/ConclusionsThis pilot study will eventually lead to an improved version of the Portuguese version of the START manual. So far, the intervention seems appropriate for selected caregivers in Portugal. However, response to striking unmet needs, particularly basic home support, may need to precede interventions like START. We look forward to concluding the intervention study and analyzing the implementation challenges, as a basis to inform a wider-scale trial.

scholarly journals A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study

10.2196/13440 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e13440 ◽  
Author(s):  
Nicholas Bott ◽  
Sharon Wexler ◽  
Lin Drury ◽  
Chava Pollak ◽  
Victor Wang ◽  
...  
Keyword(s):  
Older Adults ◽  
Los Angeles ◽  
Social Engagement ◽  
Depression Scale ◽  
Control Unit ◽  
Assessment Method ◽  
Conversational Agents ◽  
Pilot Studies ◽  
Human In The Loop ◽  
Hospitalized Older Adults

Background Hospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of relational ECA, provided by Care Coach (care.coach, inc): an animated animal avatar on a tablet device, monitored and controlled by live health advocates. The ECA implemented algorithm-based clinical protocols for hospitalized older adults, such as reorienting patients to mitigate delirium risk, eliciting toileting needs to prevent falls, and engaging patients in social interaction to facilitate social engagement. Previous pilot studies of the Care Coach avatar have demonstrated the ECA’s usability and efficacy in home-dwelling older adults. Further study among hospitalized older adults in a larger experimental trial is needed to demonstrate its effectiveness. Objective The aim of the study was to examine the effect of a human-in-the-loop, protocol-driven relational ECA on loneliness, depression, delirium, and falls among diverse hospitalized older adults. Methods This was a clinical trial of 95 adults over the age of 65 years, hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on a control unit received a daily 15-min visit from a nursing student. Measures of loneliness (3-item University of California, Los Angeles Loneliness Scale), depression (15-item Geriatric Depression Scale), and delirium (confusion assessment method) were administered upon study enrollment and before discharge. Results Participants who received the avatar during hospitalization had lower frequency of delirium at discharge (P<.001), reported fewer symptoms of loneliness (P=.01), and experienced fewer falls than control participants. There were no significant differences in self-reported depressive symptoms. Conclusions The study findings validate the use of human-in-the-loop, relational ECAs among diverse hospitalized older adults.

scholarly journals Long-Term Acute Care Hospital Use of Non-Mechanically Ventilated Hospitalized Older Adults

2018 ◽  
Vol 66 (11) ◽  
pp. 2112-2119 ◽  
Author(s):  
Anil N. Makam ◽  
Oanh Kieu Nguyen ◽  
Lei Xuan ◽  
Michael E. Miller ◽  
Ethan A. Halm
Keyword(s):  
Older Adults ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Mechanically Ventilated ◽  
Hospitalized Older Adults ◽  
Hospital Use

scholarly journals Self-Efficacy of Family Caregivers of Older Adults With Cognitive Impairment: A Concept Analysis

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 75-75
Author(s):  
Tarik Khan ◽  
Karen Hirschman ◽  
Matthew D McHugh ◽  
Mary Naylor ◽  
Tarik S Khan
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Family Caregivers ◽  
Self Efficacy ◽  
Medical Information ◽  
Concept Analysis ◽  
Policy Implications ◽  
Care Access ◽  
Medical Issues ◽  
Definition Of

Abstract The purpose of this concept analysis is to address fundamental gaps in the understanding of self-efficacy in family caregivers of older adults with cognitive impairment, including updating the 26-year-old concept analysis with a contemporary definition. With the first of the baby boomers set to turn 75 in 2021, the growing number of Americans with Alzheimer’s disease is predicted to more than double over the next 30 years, while the pool of potential family caregivers is likely to diminish by half. Research demonstrates that increased self-efficacy can help family caregivers of older adults with Alzheimer’s and other types of cognitive impairment experience lower burden and depressive symptom severity. This study utilized Walker and Avant’s method of concept analysis, an eight-step iterative process that helps to clarify the meaning of ambiguous concepts. A literature review was conducted from July 1993 through March 2019 using PubMed/MEDLINE, Scopus, CINAHL, and Embase. Eight defining attributes of this concept were identified. The revised definition of self-efficacy in this population is “a family caregiver’s confidence in their ability to: manage behaviors and other caregiving stresses, control upsetting thoughts, acquire medical information, manage medical issues, obtain self-care, access community supports, assist with activities of daily living and other care, and maintain a good relationship with a relative, friend, or neighbor of an older adult with cognitive impairment.” Practice implications include tailoring interventions to improve family caregiver self-efficacy. Policy implications include fostering evidence-based health strategies through payment and delivery incentives that further support caregiver self-efficacy.

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