Seeing the wood for the trees. Carer related research and knowledge: A scoping review

This NIHR-SSCR funded scoping review provides a comprehensive mapping of what is known about carers and caring, and aims to help inform policy, practice and research in relation to carers. The review was undertaken by searching 10 electronic bibliographic databases, supplemented by additional web searches to identify academic research, grey literature and wider knowledge. The analysis adopts a selective thematic approach covering: carer variables - the characteristics of different types of carer and different caring situations; types of care - the nature of needs of the cared for person and the features of the care situation; the impact of caring – resilience and coping, employment and health; and carer support and needs assessment. The final section highlights key messages identified from the review. It found that caring involves all sections and age groups of the population, with people are likely to experience one or more periods of caregiving over their lifetime. The uniqueness of each caring relationship is also highlighted. In relation to types of carers, knowledge about ‘hard to reach’ groups, such as BAME and LGBT carers, remains sparse. Older carers are also relatively invisible in policy and research terms. It found that much of the knowledge about carers identified in the review relates to their characteristics, their lived experience and the nature of their caregiving, with relatively less being known about the effectiveness of interventions to support them. The report concludes by offering suggestions for policy and practice. An appendix provides a bibliography of the 3,434 items identified in review, classified into 17 types of reference

Living at home with dementia: a client-centered program for people with dementia and their caregivers

Thesis (O.T.D.)--Boston UniversityThe number of elderly Americans is increasing rapidly, and dementia is prevalent within this population, especially among the growing group of people over the age of 90 (National Institutes of Health, 2011; Plassman, et al., 2007). The majority of elderly people, including many with dementia, report that they would like to stay in their own homes, which is cost effective for the family and community (Keenan, 2010; Alzheimer's Association, 2012). In addition, people with dementia who live at home are happier, safer, and more independent than those who have been placed into another setting (Alzheimer's Society, 2013). However, they present with a variety of health and safety concerns which have an impact on both their own and their caregivers' quality of life (Allan, et al., 2009; Etters, et al., 2007, Gitlin, 2010). Described in this doctoral project is a caregiver- and client-centered program geared towards delaying or even avoiding long-term care placement of people with dementia by helping to increase client tranquility, independence, and safety, therefore decreasing daily challenges and caregiver feelings of burden. Through this intervention, caregivers will be empowered with skills and strategies with which to engage and support their loved one with dementia, as they are educated regarding the following elements: methods for promoting autonomy in self-care; ways of incorporating meaningful activity into the daily routine; methods for increasing home safety; and strategies for challenging behaviors. This program incorporates a personalized approach, the inclusion of meaningful activity, safe and effective strategies for daily tasks, and an introduction to technology aides and adaptive equipment. A thorough review of the literature was completed in order to ascertain the most effective strategies for addressing the problems affecting informal home caregivers. Best practices are incorporated into the group and individual session structure, and included is a detailed information packet for clients with guidance regarding each of the 14 topics included in the program: information about dementia; fall prevention at home; self-care tasks; successful mealtimes; cooking and kitchen safety; medication management; using the telephone/emergency assistance; wandering and getting lost; rummaging, hiding, and hoarding solutions; sleep strategies; meaningful activity; the preferences worksheet; life story books; and useful resources

Focal Spot, Fall/Winter 1998

https://digitalcommons.wustl.edu/focal_spot_archives/1080/thumbnail.jp

Washington University Record, April 16, 1998

https://digitalcommons.wustl.edu/record/1791/thumbnail.jp

Health care professionals’ caretaking of persons with dementia who use dietary supplements

Persons with dementia experience progressive loss of cognitive functioning and increasing need for help with activities of daily living, including help with administering their prescribed drugs (PD). This thesis describes the use of dietary supplements (DS) (including herbs) by persons with dementia and the risk related to their use, as DS may cause adverse effects. It further describes the awareness of this risk and the attributed responsibility by relevant health care professionals in primary health care. The study methods used were questionnaire-surveys of patients with dementia (n=151), employees in pharmacy (n=105) and home care service (HCS) (n=231), and individual interviews with general practitioners (GPs) (n=14). Forty-six percent of the persons with dementia used DS and 11% had potentially clinically relevant interactions between DS and PD. Only one-third of the patients received help with the administration of their DS. Several of the patients who did not receive help had cognitive decline, indicating a need for such help. Only one-third of the patients with dementia and half of their caretakers knew that DS may impose a health-risk. Half of the general practitioners (GPs) and the employees in home care service (HCS), but few pharmacy employees, expressed that they had been worried about patients’ DS use. One-third of the employees in HCS and two-third of the GPs had intervened because of possibly dangerous use. None of the studied health care professionals attributed the responsibility for the safety of these patients to their own profession. The main reason why the GPs did not want to take on the responsibility was the lack of available information about safety, effect and sometimes even DS-content. Conclusion: DS use are common in patients with dementia and may represent a risk to them, but no group of health care professionals wants to take the responsibility to increase their safety

Supervised machine learning in psychiatry:towards application in clinical practice

In recent years, the field of machine learning (often named with the more general term artificial intelligence) has literally exploded and its application has been proposed in basically all fields, including psychiatry and mental health. This has been motivated by the promise of using machine learning to develop new clinical tools that could help perform personalized predictions and recommendations, ultimately improving the results achievable in the psychiatric clinical practice that still faces only a limited success in the fight against mental diseases. However, despite this huge interest, there is still a substantial lack of tools in psychiatry that are based on machine learning algorithms. Massimiliano Grassi, in his Ph.D. thesis, investigates the challenges of translating machine learning algorithms into clinical practice and proposes innovative solutions to these challenges. The thesis presents the development and validation of new algorithms for the prediction of the onset of Alzheimer’s disease, the remission of obsessive-compulsive disorder, and the automatization of sleep staging in polysomnography, a method to diagnose sleep disorders. The results from these studies demonstrate that the use of machine learning in psychiatric clinical practice is not just a promise, and it is possible to develop machine learning algorithms that achieve clinically relevant performance even if based solely on information that can be easily accessible in the daily clinical routine