Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-22T23:55:33.970Z Has data issue: false hasContentIssue false

Understanding the educational and support needs of informal care-givers of people with dementia attending an outpatient geriatric assessment clinic

Published online by Cambridge University Press:  28 August 2018

Thom J. Ringer*
Affiliation:
GERAS Centre, St. Peter's Hospital, Hamilton, Ontario, Canada Mount Sinai Academic Family Health Team, Toronto, Ontario, Canada
Matthew Wong-Pack
Affiliation:
GERAS Centre, St. Peter's Hospital, Hamilton, Ontario, Canada University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
Patricia Miller
Affiliation:
GERAS Centre, St. Peter's Hospital, Hamilton, Ontario, Canada School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
Christopher Patterson
Affiliation:
GERAS Centre, St. Peter's Hospital, Hamilton, Ontario, Canada Department of Geriatric Medicine, McMaster University, Hamilton, Ontario, Canada
Sharon Marr
Affiliation:
GERAS Centre, St. Peter's Hospital, Hamilton, Ontario, Canada Department of Geriatric Medicine, McMaster University, Hamilton, Ontario, Canada
Brian Misiaszek
Affiliation:
GERAS Centre, St. Peter's Hospital, Hamilton, Ontario, Canada Department of Geriatric Medicine, McMaster University, Hamilton, Ontario, Canada
Tricia Woo
Affiliation:
GERAS Centre, St. Peter's Hospital, Hamilton, Ontario, Canada Department of Geriatric Medicine, McMaster University, Hamilton, Ontario, Canada
Richard Sztramko
Affiliation:
GERAS Centre, St. Peter's Hospital, Hamilton, Ontario, Canada Department of Geriatric Medicine, McMaster University, Hamilton, Ontario, Canada
Peter George Vastis
Affiliation:
GERAS Centre, St. Peter's Hospital, Hamilton, Ontario, Canada Royal College of Surgeons in Ireland, Dublin, Ireland
Alexandra Papaioannou
Affiliation:
GERAS Centre, St. Peter's Hospital, Hamilton, Ontario, Canada Department of Geriatric Medicine, McMaster University, Hamilton, Ontario, Canada
*
*Corresponding author. Email: [email protected]

Abstract

Informal (unpaid) care-givers of older people with dementia experience stress and isolation, causing physical and psychiatric morbidity. Comprehensive geriatric assessment clinics represent an important geriatrician-led model of dementia care. Our qualitative study examined the educational and support needs of care-givers of people diagnosed with dementia at a geriatric assessment clinic, resources used to address those needs and challenges experienced in doing so. We conducted structured thematic analysis of interviews with 18 informal care-givers. Participants’ narratives reflected four themes. First, care-givers sought information from varied sources, including the Alzheimer Society, the internet and clinic staff. Responsive behaviours, the expected progression of dementia and system navigation were topics of particular interest. Second, care-givers obtained assistance from public, for-profit and voluntary sources. Third, care-givers received little assistance. Two-thirds received fewer than four hours of help weekly from all sources combined, and none more than 15. Several received no assistance whatsoever. Publicly funded support workers’ tasks, and their timing, were often unhelpful. Finally, while numerous care-givers felt physical and emotional strain, and worried about how poor health impaired their care-giving, many hesitated to seek help. The needs of this unique population of informal care-givers can be met by improved home-care service flexibility, and access to trustworthy information about the expected progression of dementia and skills for managing behavioural and psychological symptoms.

Type
Article
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aguglia, E, Onor, ML, Trevisiol, M, Negro, C, Saina, M and Maso, E (2004) Stress in the caregivers of Alzheimer's patients: an experimental investigation in Italy. American Journal of Alzheimers Disease and Other Dementias 19, 248252.Google Scholar
Alzheimer Society of Canada (2010) Rising Tide: The Impact of Dementia on Canadian Society. Available at http://www.alzheimer.ca/~/media/Files/national/Advocacy/ASC_Rising_Tide_Full_Report_e.pdf.Google Scholar
Asai, MO and Kameoka, VA (2005) The influence of Sekentei on family caregiving and underutilization of social services among Japanese caregivers. Social Work 50, 111118.Google Scholar
Bertrand, RM, Fredman, L and Saczynski, J (2006) Are all caregivers created equal? Stress in caregivers to adults with and without dementia. Journal of Aging and Health 18, 534551.Google Scholar
Boult, C, Boult, LB, Morishita, L, Dowd, B, Kane, RL and Urdangarin, CF (2001) A randomized clinical trial of outpatient geriatric evaluation and management. Journal of the American Geriatrics Society 49, 351359.Google Scholar
Braun, V and Clarke, V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77101.Google Scholar
Brodaty, H and Donkin, M (2009) Family caregivers of people with dementia. Dialogues in Clinical Neuroscience 11, 217228.Google Scholar
Cerejeira, J, Lagarto, L and Mukaetova-Ladinska, EB (2012) Behavioral and psychological symptoms of dementia. Frontiers in Neuroscience 3, 73.Google Scholar
Chertkow, H, Feldman, HH and Jacova, C (2013) Definitions of dementia and predementia states in Alzheimer's disease and vascular cognitive impairment: consensus from the Canadian conference on diagnosis of dementia. Alzheimers Research and Therapy 5, supplement 1, S2.Google Scholar
Cohen, CA, Colantonio, A and Vernich, L (2002) Positive aspects of caregiving: rounding out the caregiver experience. International Journal of Geriatric Psychiatry 17, 184188.Google Scholar
Cohen, HJ, Feussner, JR, Weinberger, M, Carnes, M, Hamdy, RC, Hsieh, F, Phibbs, C, Courtney, D, Lyles, KW, May, C, McMurtry, C, Pennypacker, L, Smith, DM, Ainslie, N, Hornick, T, Brodkin, K and Lavori, P (2002) A controlled trial of inpatient and outpatient geriatric evaluation and management. New England Journal of Medicine 346, 905912.Google Scholar
Committee on Family Caregiving for Older Adults, Board on Health Care Services, Health and Medicine Division and National Academies of Sciences, Engineering, and Medicine (2016) Programs and supports for family caregivers of older adults. In Schulz, R and Eden, J (eds), Families Caring for an Aging America. National Academies Press, Washington, DC. 5-1-5-34. Available at https://www.johnahartford.org/images/uploads/reports/Family_Caregiving_Report_National_Academy_of_Medicine_IOM.pdf.Google Scholar
Denton, M, Ploeg, J, Tindale, J, Hutchison, B, Brazil, K, Akhtar-Danesh, N, Quinlan, M, Lillie, J, Millen Plenderleith, J and Boos, L (2008) Where would you turn for help? Older adults’ awareness of community support services. Canadian Journal on Aging 27, 359370.Google Scholar
Dillon, WA, Prorok, JC and Seitz, DP (2013) Content and quality of information provided on Canadian dementia websites. Canadian Geriatrics Journal 16, 615.Google Scholar
Donnellan, WJ, Bennett, KM and Soulsby, LK (2015) What are the factors that facilitate or hinder resilience in older spousal dementia carers? A qualitative study. Aging and Mental Health 19, 932–9.Google Scholar
Farran, CJ, Paun, O and Elliott, MH (2003) Spirituality in multicultural caregivers of persons with dementia. Dementia 2, 353377.Google Scholar
Fereday, J, Muir-Cochrane, E (2006) Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods 5, 8092.Google Scholar
Herrera, AP, George, R, Angel, JL, Markides, K and Torres-Gil, F (2013) Variation in older Americans Act caregiver service use, unmet hours of care, and independence among hispanics, African Americans, and whites. Home Health Care Services Quarterly 32, 3556.Google Scholar
Hilgeman, MM, Allen, RS, DeCoster, J and Burgio, LD (2007) Positive aspects of caregiving as a moderator of treatment outcome over 12 months. Psychology and Aging 22, 361371.Google Scholar
Howes, C (2008) Love, money, or flexibility: what motivates people to work in consumer-directed home care? The Gerontologist 48, supplement 1, 4660.Google Scholar
Hsueh, KH, Hu, J and Clarke-Ekong, S (2008) Acculturation in filial practices among U.S. Chinese caregivers. Qualitative Health Research 18, 775785.Google Scholar
Katz, S, Downs, TD, Cash, HR and Grotz, RC (1970) Progress in development of the index of ADL. Gerontologist 10, 2030.Google Scholar
Kernisan, LP, Sudore, RL and Knight, SJ (2010) Information-seeking at a caregiving website: a qualitative analysis. Journal of Medical Internet Research 12, 3, e31.Google Scholar
Lawton, MP and Brody, EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9, 179186.Google Scholar
Leino-Kilpi, H, Roe, B, Soto, MM, Saks, K, Stephan, A, Zwakhalen, S, Zabalegui, A and Karlsson, A (2016) Formal support for informal caregivers to older persons with dementia through the course of the disease: an exploratory, cross-sectional study. BMC Geriatrics 16, 32.Google Scholar
Manuel, DG, Garner, R, Finès, P, Bancej, C, Flanagan, W, Tu, K, Reimer, K, Chambers, LW and Bernier, J (2016) Alzheimer's and other dementias in Canada, 2011 to 2031: a microsimulation Population Health Modeling (POHEM) study of projected prevalence, health burden, health services, and caregiving use. Population Health Metrics 14, 37.Google Scholar
McAiney, CA, Hillier, LM, Stolee, P, Harvey, D and Michael, J (2012) ‘Throwing a lifeline’: the role of First Link™ in enhancing support for individuals with dementia and their caregivers. Neurodegenerative Disease Management 2, 623638.Google Scholar
McMaster University (nd) McMaster Optimal Aging Portal. Available at https://www.mcmasteroptimalaging.org.Google Scholar
Miller, PA, Sinding, C, Griffith, LE, Shannon, HS and Raina, P (2016) Seniors’ narratives of asking (and not asking) for help after a fall: implications for identity. Ageing & Society 36, 240258.Google Scholar
Moore, A, Patterson, C, Lee, L, Vedel, I and Bergman, H (2014) Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia: recommendations for family physicians. Canadian Family Physician 60, 433438.Google Scholar
Ontario Dementia Caregiver Needs Project, Dupuis, L, Epp, T and Smale, B (2004) Caregivers of Persons with Dementia: Roles, Experiences, Supports, and Coping. Available at https://careforce.ca/assets/docs/resources/InTheirOwnVoices-LiteratureReview.pdf.Google Scholar
Patmore, C and McNulty, A (2005) Making Home Care for Older People More Flexible and Person-centred. Available at http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.488.7053&rep=rep1&type=pdf.Google Scholar
Peel, E and Harding, R (2014) ‘It's a huge, the system, it's a terrible maze’: dementia carers’ constructions of navigating health and social care services. Dementia 13, 642661.Google Scholar
Pinquart, M and Sörensen, S (2004) Associations of caregiver stressors and uplifts with subjective well-being and depressive mood: a meta-analytic comparison. Aging and Mental Health 8, 438449.Google Scholar
Ploeg, J, Denton, M, Tindale, J, Hutchison, B, Brazil, K, Akhtar-Danesh, N, Lillie, J and Plenderleith, JM (2009) Older adults’ awareness of community health and support services for dementia care. Canadian Journal of Ageing 28, 359370.Google Scholar
Prorok, JC, Horgan, S and Seitz, DP (2013) Health care experiences of people with dementia and their caregivers: a meta-ethnographic analysis of qualitative studies. Canadian Medical Association Journal 183, e669e680.Google Scholar
Ringer, T, Wong Pack, M, Miller, P, Patterson, C, Marr, S, Misiaszek, B, Woo, T, Sztramko, R, Vastis, P and Papaioannou, A (2017) Understanding the educational and support needs of caregivers of patients diagnosed with dementia. Journal of the American Geriatrics Society 65, supplement 1, S119.Google Scholar
Schulz, R and Sherwood, PR (2008) Physical and mental effects of family caregiving. American Journal of Nursing 108, supplement 9, 2327.Google Scholar
Silverman, M, Musa, D, Martin, DC, Lave, JR, Adams, J and Ricci, EM (1995) Evaluation of outpatient geriatric assessment: a randomized multi-site trial. Journal of the American Geriatrics Society 43, 733740.Google Scholar
Smith-Carrier, T, Pham, T-N, Akhtar, S, Seddon, G, Nowaczynski, M and Sinha, SK (2018) ‘It's not just the word care, it's the meaning of the word … (they) actually care’: caregivers’ perceptions of home-based primary care in Toronto, Ontario. Ageing & Society 38, 20192040.Google Scholar
Soobiah, C, Daly, C, Blondal, E, Ewusie, J, Ho, J, Elliott, MJ, Yue, R, Holroyd-Leduc, J, Liu, B, Marr, S, Basran, J, Tricco, AC, Hamid, J and Straus, SE (2017) An evaluation of the comparative effectiveness of geriatrician-led comprehensive geriatric assessment for improving patient and healthcare system outcomes for older adults: a protocol for a systematic review and network meta-analysis. Systematic Reviews 6, 65.Google Scholar
Tarlow, BJ, Wisniewski, SR, Belle, SH, Rubert, M, Ory, MG and Gallagher-Thompson, D (2004) Positive aspects of caregiving, contributions of the REACH project to the development of a new measure for Alzheimer's caregiving. Research on Aging 26, 429453.Google Scholar
Thompson, CA, Spilsbury, K, Hall, J, Birks, Y, Barnes, C and Adamson, J (2007) Systematic review of information and support interventions for caregivers of people with dementia. BMC Geriatrics 7, 18.Google Scholar
Winslow, BW (2003) Family caregivers’ experiences with community services: a qualitative analysis. Public Health Nursing 20, 341348.Google Scholar
Zarit, SH, Gaugler, JE and Jarrot, SE (1999) Useful services for families: research findings and directions. International Journal of Geriatric Psychiatry 14, 165166.Google Scholar
Zarit, SH, Orr, NK and Zarit, JM (1985) The Hidden Victims of Alzheimer's Disease: Families Under Stress. New York, NY: New York University Press.Google Scholar
Supplementary material: PDF

Ringer et al. supplementary material

Ringer et al. supplementary material
Download Ringer et al. supplementary material(PDF)
PDF 251.5 KB