scholarly journals The consequences of COVID-19 lockdown for formal and informal resource utilization among home-dwelling people with dementia: results from the prospective PAN.DEM study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maarja Vislapuu ◽  
Renira C. Angeles ◽  
Line I. Berge ◽  
Egil Kjerstad ◽  
Marie H. Gedde ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Ordinary Least Squares ◽  
Living Alone ◽  
Personal Hygiene ◽  
Care Utilization ◽  
Formal Care ◽  
Home Nursing ◽  
Clinical Variables ◽  
Link Type ◽  
People With Dementia

Abstract Background COVID-19 isolated home-dwelling people with dementia (PwD) from home care services, respite care, and daytime activities. We aimed to investigate the consequences of these restrictions on informal (family, friends) and formal (homecare staff) resource utilization among co-residing (e.g., spouses) and visiting caregivers (e.g., children). Methods 105 PwD (≥65 years old) and their caregivers were included in the prospective PANdemic in DEMentia (PAN.DEM) study, which was initiated when the ongoing stepped-wedge, cluster randomized [email protected] trial (N = 438) was temporarily halted due to the pandemic. Primary outcome was change in resource utilization assessed by the Resource Utilization in Dementia Care (RUD) instrument in pre- (12 Dec. 2019 to 11 Mar. 2020) and during the lockdown periods (20 April 2020 to 15 May 2020). Degree of cognitive impairment was assessed by Mini-Mental Status Examination (MMSE), and physical functioning and independent living skills by Physical Self-Maintenance Scale and Lawton Instrumental Activities of Daily Living Scale. Associations between informal and formal care utilization, socio-demographics, and clinical variables were assessed by descriptive statistics and Ordinary Least Squares models (OLS). Results Mean age for PwD was 81.8 years; 61% were female; 45.6% lived alone, and the mean MMSE score was 20.8 (SD ± 3.7). PwD with co-residents (44%) were younger (78.4 years) than those who were living alone (84.5 years; P < 0.001). During the first 2 months of lockdown, PwD missed on average 20.5 h of formal care in a month (P < 0.001) leading to an approximately 100% increase in informal care, which was particularly pronounced in personal hygiene (6.9 vs. 11.4 days in a month, P < 0.001) and supervision (9.2 vs. 17.6 days in a month; P < 0.001). Visiting caregivers increased by 1.9 days (SD ± 11.5), but co-residing caregivers increased their number of days providing ADL by approximately 7 days per month (β = 6.9; CI, 0.39–13.1, P < 0.05) after adjusting for PwD and caregiver demographics and clinical variables. Decrease in home nursing care was particularly visible for PwD living alone (− 6.1 vs. -1.3 h per month, P = 0.005). Higher cognitive function (β = − 0.64, CI, − 1.26 – 0.02, P = 0.044) was associated with reduction in home nursing service during the lockdown. Conclusion The care situation for PwD changed dramatically in the early phase of the COVID-19 pandemic, especially for those living alone who received less support from homecare services and visiting caregivers. For future crises and the forthcoming post-pandemic period, health authorities must plan better and identify and prioritize those in greatest need. Trial registration ClinicalTrials.gov; NCT04043364.

Patterns and Impact of Electronic Health Records-Defined Depression Phenotypes in Spine Surgery

Neurosurgery ◽  
2021 ◽  
Author(s):  
Maxwell Boakye ◽  
Mayur Sharma ◽  
Shawn Adams ◽  
Thomas Chandler ◽  
Dengzhi Wang ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Spine Surgery ◽  
Healthcare Resource Utilization ◽  
Care Utilization ◽  
Complication Rates ◽  
Psychiatric Condition ◽  
Opioid Use ◽  
International Classification Of Disease ◽  
Chronic Opioid Use ◽  
Poor Outcomes

Abstract BACKGROUND Preoperative depression is a risk factor for poor outcomes after spine surgery. OBJECTIVE To understand effects of depression on spine surgery outcomes and healthcare resource utilization. METHODS Using IBM’s MarketScan Database, we identified 52 480 patients who underwent spinal fusion. Retained patients were classified into 6 depression phenotype groups based on International Classification of Disease, 9th/10th Revision (ICD-9/10) codes and use/nonuse of antidepressant medications: major depressive disorder (MDD), other depression (OthDep), antidepressants for other psychiatric condition (PsychRx), antidepressants for physical (nonpsychiatric) condition (NoPsychRx), psychiatric condition only (PsychOnly), and no depression (NoDep). We analyzed baseline demographics, comorbidities, healthcare utilization/payments, and chronic opioid use. RESULTS Breakdown of groups in our cohort: MDD (15%), OthDep (12%), PsychRx (13%), NonPsychRx (15%), PsychOnly (12%), and NoDep (33%). Postsurgery: increased outpatient resource utilization, admissions, and medication refills at 1, 2, and 5 yr in the NoDep, PsychOnly, NonPsychRx, PsychRx, and OthDep groups, and highest in MDD. Postoperative opioid usage rates remained unchanged in MDD (44%) and OthDep (36%), and reduced in PsychRx (40%), NonPsychRx (31%), and PsychOnly (20%), with greatest reduction in NoDep (13%). Reoperation rates: 1 yr after index procedure, MDD, OthDep, PsychRx, NonPsychRx, and PsychOnly had more reoperations compared to NoDep, and same at 2 and 5 yr. In NoDep patients, 45% developed new depressive phenotype postsurgery. CONCLUSION EHR-defined classification allowed us to study in depth the effects of depression in spine surgery. This increased understanding of the interplay of mental health will help providers identify cohorts at risk for high complication rates, and health care utilization.

scholarly journals Carers’ experiences of timely access to and use of dementia care services in eight European countries

2019 ◽  
pp. 1-18 ◽  
Author(s):  
Hannah Jelley ◽  
Liselot Kerpershoek ◽  
Frans Verhey ◽  
Claire Wolfs ◽  
Marjolein de Vugt ◽  
...  
Keyword(s):  
Service Use ◽  
Study Participant ◽  
Formal Care ◽  
Structured Interviews ◽  
Care Services ◽  
People With Dementia ◽  
Timely Access ◽  
Mixed Feelings ◽  
Barriers To Service ◽  
Person With Dementia

AbstractTimely access to care services is crucial to support people with dementia and their family carers to live well. Carers of people with dementia (N = 390), recruited from eight countries, completed semi-structured interviews about their experiences of either accessing or not using formal care services over a 12-month period in the Access to Timely Formal Care (Actifcare) study. Participant responses were summarised using content analysis, categorised into clusters and frequencies were calculated. Less than half of the participants (42.3%) reported service use. Of those using services, 72.8 per cent reported timely access and of those not using services 67.2 per cent were satisfied with this situation. However, substantial minorities either reported access at the wrong time (27.2%), or feeling dissatisfied or mixed feelings about not accessing services (32.8%). Reasons for not using services included use not necessary yet, the carer provided support or refusal. Reasons given for using services included changes in the condition of the person with dementia, the service's ability to meet individual needs, not coping or the opportunity to access services arose. Facilitators and barriers to service use included whether participants experienced supportive professionals, the speed of the process, whether the general practitioner was helpful, participant's own proactive attitude and the quality of information received. To achieve timely support, simplified pathways to use of formal care services are needed.

scholarly journals Necessidades de Cuidados e Recurso aos Serviços na Demência: Avaliação Inicial da Coorte Portuguesa no Estudo Actifcare

2019 ◽  
Vol 32 (5) ◽  
pp. 355 ◽  
Author(s):  
Manuel Gonçalves-Pereira ◽  
Maria J. Marques ◽  
Conceição Balsinha ◽  
Alexandra Fernandes ◽  
Ana Sá Machado ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Unmet Needs ◽  
Community Support ◽  
Community Dwelling ◽  
Formal Care ◽  
Needs For Care ◽  
People With Dementia ◽  
Moderate Dementia ◽  
Formal Services ◽  
Timely Access

Introduction: People with dementia and their relatives should have timely access to formal care in the community. The EU-Actifcare project analysed access to and use of formal services, as related to unmet needs for care. We describe the cohort study implementation and baseline results in Portugal, with a focus on needs for care and service use assessments.Material and Methods: Our convenience sample consisted of 66 dyads of community-dwelling people with mild to moderate dementia and no significant use of formal services, and their informal carers. Measures included the Camberwell Assessment of Need for the Elderly and Resources Utilization in Dementia.Results: People with dementia had unmet needs (mean 1.1; SD 1.7), mainly regarding company (23%), psychological distress (20%), and daily activities (14%). Family caregivers spent 150 minutes/day (median) providing support, and 44% had psychological distress unmet needs. Problems with access to or use of formal services, when present, were frequently due to attitudes or lack of knowledge of any or both members of the dyad.Discussion: The recruitment process was challenging, since the inclusion criteria were restrictive. Not claiming generalizability, we recruited a typical sample of Portuguese people with mild to moderate dementia and no significant formal community support. Levels and type of unmet needs found in some participants would call for formal support, were it not for problems regarding access or use.Conclusion: There are difficulties regarding timely access and effective use of formal care in dementia, along with relevant unmet needs.

scholarly journals Health Status and Health Care Utilization of Multiple Sclerosis in Canada

2007 ◽  
Vol 34 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Sheri L. Pohar ◽  
C. Allyson Jones ◽  
Sharon Warren ◽  
Karen V.L. Turpin ◽  
Kenneth Warren
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Status ◽  
General Population ◽  
Health Care Utilization ◽  
Resource Utilization ◽  
Health Behaviours ◽  
Health Care Resource ◽  
Care Utilization ◽  
Health Care Resource Utilization

Background:Persons with multiple sclerosis (MS) represent a small segment of the population, but given the progression of the disease, they experience substantial physical, psychosocial and economic burdens.Objective:The primary aim was to compare demographic characteristics, health status, health behaviours, health care resource utilization and access to health care of the community dwelling populations with and without MS.Methods:Cross-sectional survey using data from the Canadian Community Health Survey (CCHS 1.1). Adjusted analyses were performed to assess differences between persons with MS and the general population, after controlling for age and sex. Normalized sampling weights and bootstrap variance estimates were used.Results:Respondents with MS were 7.6 times (95% CI: 5.4, 10.7) more likely to have health-related quality of life scores that reflected severe impairment than respondents without MS. Respondents with MS were 12.2 times (95% CI: 8.6, 17.2) to rate their health as ‘poor’ or ‘fair’ than the general population. Urinary incontinence and chronic fatigue syndrome were 18.7 times (95% CI: 12.5, 28.2) and 21.9 times (95% CI: 11.9, 40.3), more likely to be reported by respondents with MS than those without. Differences between the two populations also existed in terms of health care resource utilization and access and health behaviours.Conclusion:Large discrepancies in health status and health care utilization existed between persons with MS who reside in the community and the general population according to all indicators used. Health care needs of persons with MS were also not met.

scholarly journals Future outlook of people living alone with early-stage dementia and their non-resident relatives and friends who support them

2020 ◽  
pp. 1-21 ◽  
Author(s):  
Janet Heaton ◽  
Anthony Martyr ◽  
Sharon M. Nelis ◽  
Ivana S. Marková ◽  
Robin G. Morris ◽  
...  
Keyword(s):  
Living Arrangements ◽  
Early Stage ◽  
Secondary Analysis ◽  
Living Alone ◽  
Future Research ◽  
Temporal Orientation ◽  
Future Outlook ◽  
People With Dementia ◽  
The Future ◽  
Framework Approach

Abstract Little is known about the experiences of people living alone with dementia in the community and their non-resident relatives and friends who support them. In this paper, we explore their respective attitudes and approaches to the future, particularly regarding the future care and living arrangements of those living with dementia. The study is based on a qualitative secondary analysis of interviews with 24 people living alone with early-stage dementia in North Wales, United Kingdom, and one of their relatives or friends who supported them. All but four of the dyads were interviewed twice over 12 months (a total of 88 interviews). In the analysis, it was observed that several people with dementia expressed the desire to continue living at home for ‘as long as possible’. A framework approach was used to investigate this theme in more depth, drawing on concepts from the existing studies of people living with dementia and across disciplines. Similarities and differences in the future outlook and temporal orientation of the participants were identified. The results support previous research suggesting that the future outlook of people living with early-stage dementia can be interpreted in part as a response to their situation and a way of coping with the threats that it is perceived to present, and not just an impaired view of time. Priorities for future research are highlighted in the discussion.

scholarly journals Living Alone with Mild-To-Moderate Dementia: Findings from the IDEAL Cohort

2020 ◽  
Vol 78 (3) ◽  
pp. 1207-1216
Author(s):  
Linda Clare ◽  
Anthony Martyr ◽  
Catherine Henderson ◽  
Laura Gamble ◽  
Fiona E. Matthews ◽  
...  
Keyword(s):  
Home Care ◽  
Significant Proportion ◽  
Well Being ◽  
Living Alone ◽  
Living Situation ◽  
Care Services ◽  
People With Dementia ◽  
Moderate Dementia ◽  
Health And Social Care ◽  
The Ideal

Background: A significant proportion of people with dementia live alone, but little is known about their specific needs. Objective: To understand the profile of people living alone with mild-to-moderate dementia in the UK and identify any systematic differences associated with living situation. Methods: We analyzed cross-sectional data from 1,541 people with mild-to-moderate dementia and 1,277 caregivers participating in the IDEAL cohort at the first wave of assessment. Results: There were 1,256 (81.5%) people with dementia living with others and 285 (18.5%) living alone, of whom 51 (3% of whole sample) reported little or no informal support. There were relatively few differences associated with living situation and odds ratios were generally small. People living alone were older on average, and more likely to be female, than those living with others. Those living alone were more likely to have higher cognitive ability and self-reported functional ability, and more social contact with those from other households. They were also lonelier, expressed less satisfaction with life, and used home care services and equipment more. There were no differences in symptoms, mood, quality of life, or well-being. Conclusion: The findings support the view that it is possible to ‘live well’ with mild-to-moderate dementia while living alone, given appropriate support, including home care and equipment. Nevertheless, it is important to consider how those living alone may be supported to have a more satisfactory experience, and how health and social care services can best respond to their needs.

scholarly journals ‘It's our pleasure, we count cars here’: an exploration of the ‘neighbourhood-based connections’ for people living alone with dementia

2019 ◽  
pp. 1-26 ◽  
Author(s):  
Elzana Odzakovic ◽  
Agneta Kullberg ◽  
Ingrid Hellström ◽  
Andrew Clark ◽  
Sarah Campbell ◽  
...  
Keyword(s):  
Social Networks ◽  
International Study ◽  
Community Dwelling ◽  
Living Alone ◽  
Structured Interviews ◽  
Policy And Practice ◽  
Multiple Data ◽  
People With Dementia ◽  
Study Sites ◽  
Network Mapping

AbstractThe extent of social isolation experienced by people living with dementia who reside in the community has been well acknowledged, yet little is known about how people living alone with dementia maintain neighbourhood-based connections. The purpose of this study is to examine the experiences of people with dementia who live alone, focusing upon how they establish social networks and relationships in a neighbourhood context, and how they are supported to maintain this social context within everyday life. Multiple data collection methods were used including, semi-structured interviews, walking interviews, guided home tours and social network mapping, which were conducted with 14 community-dwelling people living alone with dementia (11 women and three men) situated across the three international study sites in England, Scotland and Sweden. Data were analysed using thematic analysis. The analysis revealed four main themes: (a) making the effort to stay connected; (b) befriending by organisations and facilitated friendships; (c) the quiet neighbourhood atmosphere; and (d) changing social connections. The analysis suggests that people with dementia who live alone were active agents who took control to find and maintain relationships and social networks in the neighbourhood. Our findings indicate the need to raise awareness about this specific group in both policy and practice, and to find creative ways to help people connect through everyday activities and by spontaneous encounters in the neighbourhood.

scholarly journals 169Intensive Homecare Packages; Are they Feasible for Supporting People with Dementia Living Alone?

2017 ◽  
Vol 46 (Suppl_3) ◽  
pp. iii13-iii59
Author(s):  
Karen Neylon ◽  
Fiona Keogh ◽  
Maria Pierce ◽  
Padraic Fleming
Keyword(s):  
Living Alone ◽  
People With Dementia
Sign in / Sign up

Export Citation Format

Share Document