What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? : a systematic integrative review of the literature

Background: Research aiming to improve the hospital experience for patients with dementia and their informal carers is strongly recommended. The present review aimed to describe the research on interventions to meet the needs of people with dementia in acute hospital settings regarding physical environment, organization of care, and staff knowledge of dementia and competence in person-centred care. An integrative review design was applied. We searched for studies in PubMed, Ovid Medline, Cinahl, Embase, Swemed+, and Cochrane databases using the Mixed Methods Appraisal Tool (MMAT) for quality evaluation. Twenty-seven articles were included, describing the perspectives of people with dementia, informal carers, and professional carers. The MMAT score ranged from two to four. Twelve studies described needs and experiences, mostly using a qualitative design. Common themes and results were synthesized. The studies identified a need to enhance staff competence regarding dementia and person-centred care. Fifteen studies described interventions: two were qualitative; three used mixed method, and 10 were quantitative, of which two were randomized controlled trials and eight were observational studies. Five types of interventions were identified. Three types could positively impact staff knowledge about dementia and person-centred care. One type was experienced as positive regarding organisation of care for patients with dementia. None of the intervention studies found evidence for effects on the identified needs regarding physical environment. Conclusion: The included studies suggest that staff need more knowledge regarding dementia and person-centred dementia care and that training interventions implemented to enhance staff competence had promising results. However, there is a need for research on the needs of patients with dementia in acute hospital settings regarding physical environment and effect of design elements. There is also a scarcity of intervention studies focusing on the effect of models of care that support the psychosocial needs of patients with dementia. Keywords: dementia, acute hospital, needs, interventions, person-centred care, training, organisation, physical environmentpublishedVersio

Self-management and HeAlth Promotion in Early-stage dementia with e-learning for carers (SHAPE): Study protocol for a multi-centre randomised controlled trial

Background: With an increasing number of people with dementia worldwide and limited advancement in medical treatments, the call for new and cost-effective approaches is crucial. The utility of self-management has been proven in certain chronic conditions. However, very little work has been undertaken regarding self-management in people with dementia. Methods: The SHAPE trial will include 372 people with mild to moderate dementia to evaluate the effectiveness and cost-effectiveness of an educational programme combining approaches of self-management, health promotion, and e-learning for care partners. The study is a multi-site, single-randomised, controlled, single-blinded trial with parallel arms. The intervention arm is compared with treatment as usual. The intervention comprises a 10-week course delivered as group sessions for the participants with dementia. The sessions are designed to develop self-management skills and to provide information on the nature of the condition and the development of healthy behaviours in a supportive learning environment. An e-learning course will be provided for care partners which covers similar and complementary material to that discussed in the group sessions for the participant with dementia. Discussion: This trial will explore the effect of the SHAPE group intervention on people with mild to moderate dementia in terms of self-efficacy and improvement in key health and mental health outcomes and cost-effectiveness, along with carer stress and knowledge of dementia. Trial registration: ClinicalTrials.gov Identifier: NCT04286139, registered prospectively February 26, 2020, https://clinicaltrials.gov/ct2/show/NCT0428613

Development of best practice recommendations to enhance access to and use of formal community care services for people with dementia in Europe: a Delphi process conducted by the Actifcare project

Objectives: Home-dwelling people with dementia and their informal carers experience barriers impeding access to community care services. This study is a part of the Actifcare project where eight countries participated. The aim was to achieve consensus on best practice recommendations for enhancing access to and use of formal community care services. Method: A Delphi consensus process was conducted. A total of 48 professional experts, 14 people with dementia and 20 informal carers rated the importance of 72 statements on a 7-point Likert scale. Consensus was based on the median and level of dispersion. Results: Sixty-two statements reached consensus, resulting in three categories of recommendations. An appointed contact person was central in Recommendations to enhance access. Coordination and flexibility in setting and type of services were among the Recommendations to enhance use. Training of health care personnel and person-centred care were central Recommendations that can facilitate access or use indirectly. Conclusion: The Actifcare Best Practice Recommendations suggest practical measures that can be taken bydecision makers to enhance access and use of community care services, and there by enhance quality of care and quality of life for home dwelling people with dementia and their informal carers. Abbreviations: Actifcare: ACcess to TImely Formal Care; AE: Alzheimer Europe;; EWGPWD: European Working Group of People with Dementia;; GP: General Practitioner

Perspectives of policy and political decision makers on access to formal dementia care:Expert interviews in eight European countries

Background: As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Methods: Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. Results: The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Conclusions: Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.publishersversionpublishe

Development of best practice recommendations to enhance access to and use of formal community care services for people with dementia in Europe: a Delphi process conducted by the Actifcare project

Objectives Home-dwelling people with dementia and their informal carers experience barriers impeding access to community care services. This study is a part of the Actifcare project where eight countries participated. The aim was to achieve consensus on best practice recommendations for enhancing access to and use of formal community care services. Method A Delphi consensus process was conducted. A total of 48 professional experts, 14 people with dementia and 20 informal carers rated the importance of 72 statements on a 7-point Likert scale. Consensus was based on the median and level of dispersion. Results Sixty-two statements reached consensus, resulting in three categories of recommendations. An appointed contact person was central in Recommendations to enhance access. Coordination and flexibility in setting and type of services were among the Recommendations to enhance use. Training of health care personnel and person-centred care were central Recommendations that can facilitate access or use indirectly. Conclusion The Actifcare Best Practice Recommendations suggest practical measures that can be taken by decision makers to enhance access and use of community care services, and thereby enhance quality of care and quality of life for home dwelling people with dementia and their informal carers

Barriers and facilitators to the access to and use of formal dementia care:Findings of a focus group study with people with dementia, informal carers and health and social care professionals in eight European countries

Abstract Background People with dementia and informal carers often access formal care late in the process of dementia. The barriers and facilitators to service use from the perspectives of different stakeholders involved are not well understood. Thus, we aimed to explore the barriers and facilitators of access to and utilisation of formal care from the perspectives of people with dementia, their informal carers and health and social care professionals. Method Focus groups with people with dementia, informal carers and professionals were conducted in eight European countries. Recruitment targeted people with dementia, informal carers with experience of formal care and professionals involved in providing (access to) formal care. Qualitative content analysis using open coding was used on a national level. Cross-national synthesis was based on the translated national reports. Results Overall, 55 focus groups with 261 participants were conducted, involving 51 people with dementia, 96 informal carers and 114 professionals. Sixteen categories describing barriers and facilitators were identified, referring to three global themes: Aspects related to 1) individuals involved, 2) the system or 3) overarching aspects. The attitudes and beliefs of people with dementia and their carers may have a major impact, and they often serve as barriers. Formal care was perceived as a threat to the individual independence of people with dementia and was thus avoided as long as possible. A healthcare professional serving as a constant key contact person could be an essential facilitator to overcome these barriers. Contact should be initiated proactively, as early as possible, and a trusting and consistent relationship needs to be established. Beyond that, the findings largely confirm former research and show that barriers to accessing and using formal care still exist across Europe despite a number of national and European initiatives. Conclusion Further investigations are needed to elaborate how the concept of a key contact person could be integrated with existing case management approaches and how the independence and autonomy of people with dementia can be strengthened when formal care needs to be accessed and used. These may be meaningful facilitators regarding enhanced access to formal care for people with dementia and their families

Privatisering i pleie- og omsorgssektoren : en casestudie

Tema for denne hovedoppgaven er privatisering i pleie- og omsorgssektoren. Hovedspørsmålet er om privat en kommersiell virksomhet er mer effektiv enn kommunen i drift av sykehjem. Hva er riktige incentiver i forhold til effektivitet og kvalitet i denne tjenesten som ofte kalles den resultatløse omsorgen ?. Er det riktig at økonomiske incentiver som ligger i privatisering er det som er best egnet, eller er det sosiale incentiver som betyr mest? Hensikten med studien er å sammenligne effekten av disse to incentivsystemene på effektivitet og kvalitet i drift av sykehjem. Det er brukt casestudie, noe som betyr at resultatene ikke kan generaliseres. Det er samlet inn data om ulike aspekter ved èn enhet som sammenlignes med tilsvarende forhold ved andre tilsvarende enheter. Ulike kilder er benyttet. Analysen av caset ut fra prinsipal-agent teori, viser at det er betydelige styringsproblemer for kommunen knyttet til de grunnleggende forutsetningene i spillet mellom kommunen og den private bedriften. Fordi det ikke ble gjennomført en reell anbudsrunde, og det derfor ikke var en reell konkurranse mellom eksterne leverandører, har den private bedriften hatt og fått fordeler som svekker konkurranseelementet. Det er også asymmetrisk informasjon til fordel for bedriften fordi det er mange usikkerhetsmomenter knyttet til produksjonen både med hensyn til mål for, omfang av og kontroll på tjenestetilbudet. Pleietyngde representerer et stokastisk element/uforutsigbart forhold som det er vanskelig for kommunen å skaffe seg innsikt i, og som bedriften har privat informasjon om. Alle disse forholdene gjør at ISS i prinsippet kan opptre opportunistisk. Det er variasjon i typer kostnader mellom private og kommunale sykehjem i analysen, men det private er ikke mer effektivt enn de kommunale totalt sett, ut fra definisjonene på kostnadseffektivitet og arbeidsproduktivitet. Med de forbehold som må tas i forhold til datagrunnlaget, er kvaliteten på tjenesten det private sykehjemmet leverer ikke bedre enn det de kommunale sykehjemmene leverer, men heller ikke spesielt dårligere. Tendensene er der til at det private sykehjemmet i større grad tar i bruk økonomiske incentiver på avdelingsnivå, men variasjonene mellom det private og de kommunale institusjonene vurderes som moderate til små. ISS/Risenga har en organisasjon som preges at de har betydelig færre sykepleiere enn Asker kommune. Sykepleierne i de kommunale institusjonene tar i større grad del i arbeidet i grunnenhetene i organisasjonen enn på ISS/Risenga. Siden ISS/Risenga også har flere ledere på avdelingsplan med lavere utdanning (hjelpepleiere) enn Asker kommune, er vurderingen etter analysen at de kommunale sykehjemmene har en organisasjonskultur med et sterkere innslag av profesjonelle normer på avdelingsnivå enn ISS/Risenga. Forutsetningene for den økonomiske hypotesen er svekket i caset på grunn av forhold rundt anbud og kontrakt. Hypotesen ut fra normsosiologi om at profesjonelle normer har størst betydning for effektivitet og kvalitet får mest støtte, men til sammen drar forklaringene i retning av at liten variasjon i effektivitet og kvalitet, slik også funnene viser