A Systematic Review of Interventions for Unpaid Caregivers of Persons With Dementia

The prevalence of dementia is increasing as seniors are living longer than ever before. Due to cuts in funding for formal support such as home care and the decreased number of long-term care beds many families are having to provide care for a loved one with dementia in the community. The results of caregiving lead to both positive and negative consequences. There is an abundance of literature regarding interventions to support and maintain caregivers in the community, many with conflicting results. This study utilized a systematic review to gather and synthesize information about interventions that have an effect on the well-being of caregivers of people with dementia. The steps in a systematic review include: (a) developing a research question, (b) developing relevance and validity tools, (c) conducting a thorough literature search of published and unpublished studies, (d) using relevance and validity tools to assess the studies, (e) completing data extraction for each study, (l) synthesizing the findings and, (g) writing the report. A search of published and some unpublished articles resulted in the retrieval of 92 studies, with 36 meeting the relevance criteria. Utilizing the validity criteria, 11 studies were rated as strong, 11 moderate, 13 weak, and 1 poor. The strong and moderate studies are the focus of the review. No one intervention demonstrated an overall significant impact on the well-being of caregivers. Several interventions have been shown to be of benefit to caregivers, however, further investigation is greatly needed. Institutionalization was delayed by the psychotherapy intervention for caregivers and in one of the case management models. Caregiver depression and strain were reduced during in-hospital respite. Two educational interventions demonstrated an increase in knowledge about dementia for caregivers. Interventions individualized to the caregiver or care receiver were successful in some outcome areas. Non-significant findings were more common. The results of this study will be disseminated to interested researchers, consumers, practitioners and policy makers in a variety of formats. Systematic reviews are an important means to guide consumers and practitioners as they make evidence-based decisions

Exploring the changing relationship between formal carers, informal carers and carees during the elder-care process

There are increasing studies looking at effects of caregiving to the frail elderly in Hong Kong. However, many studies often focus only on a single dimension of caregiving in either informal or formal carers without the focus on the elderly that receiving cares. Few studies have viewed elder caregiving as an integrative and dynamic approach, with limited examination and exploration on the caring processes and interactions between the formal and informal carers and elderly carees, and the reasons for this pattern. Thus a caregiving triad might be considered as consisting of the elderly caree, the formal and informal carer, and a tripartite model could be adopted to explore the interactions and interrelationship between the three parties. The present research aimed to explore the changing caring relationships among carers and carees in home-based setting; the meanings behind the different caring patterns amongst the formal informal carers as well as the elderly carees and; to provide suggestions and implications for providing better care services for elderly recipients in home-based setting. The methods used in the present study are mainly qualitative in approach, with in-depth interviews and focus group discussion. In order to ensure the credibility of the research, triangulation of various data sources is used to provide fuller picture and understanding of the research findings. Since this is an exploratory study, a small sample was used (N=18). In order to get a deeper understanding of the caregiving process and patterns, in-depth interviews with elderly people, their family caregivers and the formal caregivers were conducted in this study. The interviews were guided by a theoretical framework with interview guidelines. Thematic analysis was used to explore the caring relationships and pattern. A total of 6 cases with 18 people (6 elderly people, 6 family caregivers and 6 formal caregivers) were successfully interviewed from June to September 2003. The present study found that between the informal and formal carers, substituting and complementing effect are the most obvious through the interaction pattern. The substituting effect mainly comes from the perception of quality services by the informal carers and they think that professional and advanced care services are better to be provided by formal carers. Regarding the complementing effect, it is found that sharing of tasks between the formal and informal carers are common through the research. Informal carers might share tasks to formal carers when they did not have time to do. Tangible supports are more often supported by formal carers and both formal and informal carers would provide intangible support. On the side of carers and carees, both formal and informal carers are found to interact in a form of reciprocal and obligation. The continuation of care of informal carers is mainly due to the martial relationship and filial piety. The caring meanings of formal carers are varies, including the economic reward, gratification and job satisfaction and also the caring can benefit their personal growth and development. The findings shed some light on the roles played by the three parties. It was necessary for all parties to cooperate in striving for the best quality of care. Hence more information of the perceived roles and expectations among the three parties should be further explored in order to get the optimal caring patterns. Since the optimum form of the caring relationships depends very much on the community resources available and also on the values upheld by the three parties, to achieve the greatest satisfaction of them and enhancing their quality of life, it is advisable to conduct further study on their expectations towards the caring tasks, process, and relationship while advocating their empowerment in the continuum of care

Ambient Assistive Technology Considered Harmful

Abstract. Ambient assistive technology (AAT) is envisioned as a powerful tool for facing the growing demands the demographic change toward an aging society puts on care. While AAT is often expected to increase the quality of life of older people, this paper holds that relevant interventions often embody values that can contradict such visions, and in some cases even be harmful to care receivers. We argue that the strong focus AAT puts on illness and risk management reflects a medical model of care, which often disregards the psychosocial challenges that impairments and disabilities associated with old age can rise. We suggest that design of AAT could benefit from using the social model of care as design inspiration and value foundation. Such an approach puts focus on the person rather than the illness. The paper ends by providing a short description of work in which the social model of care is adopted as a basis for design of AAT