Positive and negative outcomes of informal caregiving at home and in institutionalised long-term care: A cross-sectional study

Background: Our ageing society is putting tremendous strain on public health and welfare programs to meet the needs of ageing individuals. Promoting informal caregiving is one way for policymakers to reduce this burden. However, caregiving may be experienced as stressful and is associated with adverse health consequences. While quite a lot of research focuses on caregiving for community-dwelling older adults, little is known about informal care in institutionalised long-term care (ILTC). Therefore, the objectives of this study were: 1) to compare characteristics of informal caregivers and care receivers and caregiver outcomes - at home and in ILTC; 2) to study the association between these characteristics and positive and negative caregiver outcomes; 3) to investigate the moderating effect of the setting (at home vs. ILTC) on these associations. Methods: A cross-sectional study was conducted using the TOPICS-MDS DataSet. A total of 5197 Dutch dyads were included. The average age of the care receivers and caregivers was respectively 80.7 years and 63.2 years. Several sociodemographic, health-related and caregiving-related characteristics of care receiver and caregiver and two caregiver outcomes (i.e., subjective burden and care-related quality of life) were included in the analyses. Results: Caregivers in both settings experienced comparable levels of subjective burden. Caregivers at home had slightly lower care-related quality of life than caregivers in ILTC. Several care receiver characteristics (i.e., male sex, married/cohabiting, more morbidities/disability, and less self-perceived health/psychological wellbeing) and several caregiver characteristics (i.e., female sex, being younger, living together with the care receiver, more objective burden, less self-perceived health, and more support) were associated with an increase in burden and/or a decrease in care-related quality of life. Some of these associations were stronger for dyads at home compared to dyads in ILTC. Conclusions: Informal caregiving does not stop with admission to an ILTC facility. Both settings need an informal caregiving policy, which is (1) tailored to the individual characteristics of care receivers and caregivers; (2) pays attention to the identified risk groups; and (3) reduces the negative caregiver outcomes and emphasizes the positive outcomes at the same time

The reduction of disability in community-dwelling frail older people: design of a two-arm cluster randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Frailty among older people is related to an increased risk of adverse health outcomes such as acute and chronic diseases, disability and mortality. Although many intervention studies for frail older people have been reported, only a few have shown positive effects regarding disability prevention. This article presents the design of a two-arm cluster randomized controlled trial on the effectiveness, cost-effectiveness and feasibility of a primary care intervention that combines the most promising elements of disability prevention in community-dwelling frail older people.</p> <p>Methods/design</p> <p>In this study twelve general practitioner practices were randomly allocated to the intervention group (6 practices) or to the control group (6 practices). Three thousand four hundred ninety-eight screening questionnaires including the Groningen Frailty Indicator (GFI) were sent out to identify frail older people. Based on their GFI score (≥5), 360 participants will be included in the study. The intervention will receive an interdisciplinary primary care intervention. After a comprehensive assessment by a practice nurse and additional assessments by other professionals, if needed, an individual action plan will be defined. The action plan is related to a flexible toolbox of interventions, which will be conducted by an interdisciplinary team. Effects of the intervention, both for the frail older people and their informal caregivers, will be measured after 6, 12 and 24 months using postal questionnaires and telephone interviews. Data for the process evaluation and economic evaluation will be gathered continuously over a 24-month period.</p> <p>Discussion</p> <p>The proposed study will provide information about the usefulness of an interdisciplinary primary care intervention. The postal screening procedure was conducted in two cycles between December 2009 and April 2010 and turned out to be a feasible method. The response rate was 79.7%. According to GFI scores 29.3% of the respondents can be considered as frail (GFI ≥ 5). Nearly half of them (48.1%) were willing to participate. The baseline measurements started in January 2010. In February 2010 the first older people were approached by the practice nurse for a comprehensive assessment. Data on the effect, process, and economic evaluation will be available in 2012.</p> <p>Trial Registration</p> <p>ISRCTN31954692</p

The psychometric properties of three self-report screening instruments for identifying frail older people in the community

Background: Frailty is highly prevalent in older people. Its serious adverse consequences, such as disability, are considered to be a public health problem. Therefore, disability prevention in community-dwelling frail older people is considered to be a priority for research and clinical practice in geriatric care. With regard to disability prevention, valid screening instruments are needed to identify frail older people in time. The aim of this study was to evaluate and compare the psychometric properties of three screening instruments: the Groningen Frailty Indicator (GFI), the Tilburg Frailty Indicator (TFI) and the Sherbrooke Postal Questionnaire (SPQ). For validation purposes the Groningen Activity Restriction Scale (GARS) was added. Methods: A questionnaire was sent to 687 community-dwelling older people (>= 70 years). Agreement between instruments, internal consistency, and construct validity of instruments were evaluated and compared. Results: The response rate was 77%. Prevalence estimates of frailty ranged from 40% to 59%. The highest agreement was found between the GFI and the TFI (Cohen's kappa = 0.74). Cronbach's alpha for the GFI, the TFI and the SPQ was 0.73, 0.79 and 0.26, respectively. Scores on the three instruments correlated significantly with each other (GFI - TFI, r = 0.87; GFI - SPQ, r = 0.47; TFI - SPQ, r = 0.42) and with the GARS (GFI - GARS, r = 0.57; TFI - GARS, r = 0.61; SPQ - GARS, r = 0.46). The GFI and the TFI scores were, as expected, significantly related to age, sex, education and income. Conclusions: The GFI and the TFI showed high internal consistency and construct validity in contrast to the SPQ. Based on these findings it is not yet possible to conclude whether the GFI or the TFI should be preferred; data on the predictive values of both instruments are needed. The SPQ seems less appropriate for postal screening of frailty among community-dwelling older peopl

Using machine learning to assess the predictive potential of standardized nursing data for home healthcare case-mix classification

Background The Netherlands is currently investigating the feasibility of moving from fee-for-service to prospective payments for home healthcare, which would require a suitable case-mix system. In 2017, health insurers mandated a preliminary case-mix system as a first step towards generating information on client differences in relation to care use. Home healthcare providers have also increasingly adopted standardized nursing terminology (SNT) as part of their electronic health records (EHRs), providing novel data for predictive modelling. Objective To explore the predictive potential of SNT data for improvement of the existing preliminary Dutch case-mix classification for home healthcare utilization. Methods We extracted client-level data from the EHRs of a large home healthcare provider, including data from the existing Dutch case-mix system, SNT data (specifically, NANDA-I) and the hours of home healthcare provided. We evaluated the predictive accuracy of the case-mix system and the SNT data separately, and combined, using the machine learning algorithm Random Forest. Results The case-mix system had a predictive performance of 22.4% cross-validatedR-squared and 6.2% cross-validated Cumming's Prediction Measure (CPM). Adding SNT data led to a substantial relative improvement in predicting home healthcare hours, yielding 32.1%R-squared and 15.4% CPM. Discussion The existing preliminary Dutch case-mix system distinguishes client needs to some degree, but not sufficiently. The results indicate that routinely collected SNT data contain sufficient additional predictive value to warrant further research for use in case-mix system design

Optimizing patients' functional status during daily nursing care interventions:A systematic review

Patients often experience a functional decline due to physical inactivity during illness. Nurses can influence the physical activity of patients while assisting them with activities of daily living. The purpose of this study was to identify effective interventions that are embedded in daily nursing care (irrespective of care setting) that aim to optimize the functional status of patients by increasing their physical activity. A systematic review was performed and reported following the preferred reporting items for systematic reviews and meta-analyses. PubMed, CINAHL, and Cochrane were searched for studies from January 2002 to March 2019. The critical appraisal tools from the Joanna Briggs Institute were used to assess the risk of bias in individual studies. Study characteristics, intervention key components, and reported effects of included studies were extracted, summarized narratively, and compared. Twenty studies, evaluating nine different interventions were included. In these interventions, eight key components were identified. Four components were included in all six interventions with a positive effect on mobility, physical activity, or functional status. These components were: assessment of patient's functionality; goal setting with the patient; establishment of an individualized plan; and engagement of patients in physical and daily activity. The effects were limited due to the risk of bias in the studies, small sample sizes, limited clinical meaning of the effects, and variability of the adherence to the interventions. Multicomponent interventions were the most promising to enhance the functional status of patients. Future research should evaluate these interventions using research methods aiming at producing more rigorous evidence

A nurse-led interdisciplinary primary care approach to prevent disability among community-dwelling frail older people: A large-scale process evaluation

Background: The complex healthcare needs of frail older people and their increased risk of disability require an integrated and proactive approach. In the Netherlands, an interdisciplinary primary care approach has recently been developed, involving individualized assessment and interventions (tailor-made care), case management and long-term follow-up. The practice nurse as part of a general practice is case manager and plans, organizes and monitors the care process and facilitates cooperation between professionals. The approach has shown positive indications regarding its feasibility in a small pilot, but its implementation on a large scale had not hitherto been investigated. Objectives: To examine the extent to which the interdisciplinary care approach is implemented as planned and to gain insight into healthcare professionals' and frail older people's experiences regarding the benefits, burden, stimulating factors and barriers. Design: A process evaluation was conducted using a mixed methods design. Settings: Six GP practices in the south of the Netherlands. Participants: Practice nurses (n = 7), GPs (n = 12), occupational therapists (n = 6) and physical therapists (n = 20) participated in the process evaluation. Furthermore, 194 community-dwelling frail older people (&gt;= 70 years) were included using the Groningen Frailty Indicator. People who were terminally ill, were confined to bed, had severe cognitive or psychological impairments or were unable to communicate in Dutch were excluded. Methods: Quantitative data (logbooks and evaluation forms) were collected from all the participating frail older people and 13 semi-structured interviews with a selection of them were conducted. In addition, data from healthcare professionals were collected through 12 semi-structured interviews and four focus group discussions. Results: Although some parts of the protocol were insufficiently executed, healthcare professionals and frail older people were satisfied with the care approach, as it provided a useful structure for the delivery of geriatric primary care and increased the attention to preventive treatment. Frail older people felt acknowledged by healthcare professionals and experienced support in handling their problems and fulfilling their wishes. Conclusions: The findings of the study revealed several positive aspects of the interdisciplinary primary care approach. Given its complexity, the implementation of the nurse-led interdisciplinary care approach is challenging and some parts of the protocol need special attention