Living with a partner with dementia:a systematic review and thematic synthesis of spouses' lived experiences of changes in their everyday lives

ABSTRACTObjectives: Dementia causes dramatic changes in everyday-living for spouses. Occured changes in marital relationship, force spouses to perform more both mentally and physically. Leading to a spousal perceived burden. To improve understanding of spouses’ needs, spouses lived experiences is needed. The aim was to identify and synthesise qualitative studies on spouses’ lived experiences of living with a partner with dementia.Methods: A systematic search was undertaken in January 2017. Six databases (CINAHL, Cochrane Library, Embase, PubMed, PsycINFO and Sociological Abstracts) were searched, using search terms in accordance with PICo. A descriptive synthesis and a thematic synthesis were undertaken.Findings: Fifteen studies met the inclusion criteria. Three themes derived from the analysis 1) Noticing changes in everyday life 2) Transformation to a new marital relation in everyday life, withcorresponding sub-themes; changes in marital relationship, management of the transitioned marital relation in everyday life 3) Planning the future.Conclusion: Findings provide an overview of how spouses notice changes and transform their marital relationships in everyday-life. Findings offer a deeper understanding of changes that occurs over time while the partner is living at home. Findings contribute with knowledge on spouses’ experiences of changes in early-stages of dementia. Interventions supporting spouses are needed

How to Facilitate Adherence to Cardiac Rehabilitation in Primary Health Settings for Ischaemic Heart Disease Patients. The Perspectives of Health Professionals

BackgroundCardiac rehabilitation (CR) is a class 1A recommendation and an integrated part of standard treatment for patients with cardiac disease. In Denmark, CR adheres to European guidelines, it is group-based and partly conducted in primary health settings. Despite high evidence for the benefits of CR, it remains underutilized. How to facilitate CR adherence in primary health settings is poorly understood.AimThis study explores health professional's perspectives on how to facilitate CR adherence for patients with ischaemic heart disease in primary health settings.MethodsData were collected through focus group discussions. Respondents were health professionals specialized in and working with CR in primary health settings. Data were analyzed using thematic analysis.ResultsEleven health professionals participated in two focus group discussions. Five themes emerged as facilitators of CR; (1) placing the person at the center, (2) coherent programme, (3) flow of information, (4) contextual factors, and (5) feeling of belonging.ConclusionThis study illuminates the complexity of facilitating adherence to CR in primary health settings and provides ways in which health professionals may facilitate adherence. Placing the person at the center is pivotal and may be done by adapting CR offers to patients' social context, culture and life circumstances and ensuring a feeling of belonging. The rhetoric related to CR should be positive and throughout the entire course of treatment health professionals should possess a generic and collective approach to and view of CR. Perceiving these elements as potential facilitators is of vital importance and addressing them may facilitate adherence

The Adult Sensory Profile™ in Care Homes Targeting People Diagnosed with Dementia: A Qualitative Study from the Care Provider Perspective

Introduction. The background of this study is the pilot testing of the Adolescent /Adult Sensory Profile (A/ASP) in dementia units at municipal nursing homes. Based on the results from therapists’ A/ASP assessment, recommendations are made according to individual needs and forwarded to the health care providers. This study looks into the health care providers’ perspective on the usability of these recommendations. Aim. The aim of this qualitative study is to explore the health care providers’ perspective on the usability of recommendations derived from the A/ASP during a pilot testing of the profile in dementia units for people living with severe dementia. Methods. Participant observations and informal and formal interviews with health care providers at five municipal dementia units during the pilot testing of the A/ASP. Results. In the health care provider perspective, the A/ASP is a relevant and useful tool to use when behavioural challenges among residents living with dementia occur. However, in their opinion, it requires time, adjustment, and further education if recommendations are to be fully implemented in everyday practice at the dementia units

To what extent is socioeconomic status associated with not taking up and dropout from cardiac rehabilitation: a population-based follow-up study

Objectives High socioeconomic status (SES) has been linked to high referral for cardiac rehabilitation (CR). However, the impact of SES on CR utilisation from enrolment to completion is unclear. The objective of this study was to examine whether indicators of SES are associated with not taking up and dropout from CR.Design A population-based, follow-up study.Setting Hospitals and primary healthcare centres in the Central Denmark Region.Participant Patients diagnosed with ischaemic heart disease (IHD) in the hospital and referred for rehabilitation in the primary healthcare setting from 1 September 2017 to 31 August 2018 (n=2018).Variables Four SES indicators (education, disposable family income, occupation and cohabitant status) were selected because of their established association with cardiovascular health and CR utilisation. Patients were followed up regarding no uptake of or dropout from CR in the primary healthcare setting.Statistical methods The associations between the four SES indicators and either no uptake or dropout from CR were analysed using logistic regression with adjustment for age, sex, nationality and comorbidity.Results Overall, 25% (n=507) of the referred patients did not take up CR and 24% (n=377) of the participators dropped out the CR. All adjusted ORs, except one (education/dropout) demonstrated that low SES compared with high are statistically significantly associated with higher odds of not taking up CR and dropout from CR. The ORs ranged from 1.52, 95% CI 1.13 to 2.04 (education/no uptake) to 2.36, 95% CI 1.60 to 3.46 (occupation/dropout).Conclusions This study highlights that indicators of SES are important markers of CR utilisation following hospitalisation for IHD

Benefits of cardiac rehabilitation following acute coronary syndrome for patients with and without diabetes : a systematic review and meta-analysis

AIM: The benefits of cardiac rehabilitation (CR) after acute coronary syndrome (ACS) are well established. However, the relative benefit of CR in those with comorbidities, including diabetes, is not well understood. This systematic review and meta-analysis examined the benefit of CR on exercise capacity and secondary outcomes in ACS patients with a co-diagnosis of diabetes compared to those without. METHODS: Five databases were searched in May 2021 for randomised controlled trials (RCTs) and observational studies reporting CR outcomes in ACS patients with and without diabetes. The primary outcome of this study was exercise capacity expressed as metabolic equivalents (METs) at the end of CR and ≥ 12-month follow-up. Secondary outcomes included health-related quality of life, cardiovascular- and diabetes-related outcomes, lifestyle-related outcomes, psychological wellbeing, and return to work. If relevant/possible, studies were pooled using random-effects meta-analysis. RESULTS: A total of 28 studies were included, of which 20 reported exercise capacity and 18 reported secondary outcomes. Overall, the studies were judged to have a high risk of bias. Meta-analysis of exercise capacity was undertaken based on 18 studies (no RCTs) including 15,288 patients, of whom 3369 had diabetes. This analysis showed a statistically significant smaller difference in the change in METs in ACS patients with diabetes (standardised mean difference (SMD) from baseline to end of CR: - 0.15 (95% CI: - 0.24 to - 0.06); SMD at the ≥ 12-month follow-up: - 0.16 (95% CI: - 0.23 to - 0.10, four studies)). CONCLUSION: The benefit of CR on exercise capacity in ACS patients was lower in those with diabetes than in those without diabetes. Given the small magnitude of this difference and the substantial heterogeneity in the results of the study caused by diverse study designs and methodologies, further research is needed to confirm our findings. Future work should seek to eliminate bias in observational studies and evaluate CR based on comprehensive outcomes

Towards person-centred rehabilitation in dementia – a narrative synthesis

The aim of this study was to identify and synthesize person-centred principles and components as described in rehabilitation intervention studies which target home dwelling people with mild to moderate dementia. A narrative synthesis was carried out which included 19 rehabilitation intervention studies targeting people with mild to moderate dementia. The analysis was guided by an initial program theory about person-centredness in rehabilitation, which was developed for this purpose. Person-centred principles and components were identified and synthesised. Person-centred rehabilitation practice in dementia includes: (1) a focus on the needs, preferences and cultural values of the individual and consideration of his/her life history and biography; (2) the cooperation of professionals and people with dementia, including specific tools and methods such as goal-setting, holistic assessment and methods to activate and empower the individual, and building relationships; (3) organisation and structure. Compared to the principles of Kitwood, person-centredness in rehabilitation for people living with dementia also includes goal-setting and empowering principles. There is a need for developing the theoretical and philosophical foundation for person-centredness in rehabilitation in relation to people with dementia.IMPLICATION FOR REHABILITATIONPerson-centredness is a key feature in rehabilitation for people living with dementia.In rehabilitation, person-centredness may entail other principles and components than in dementia care in general.There is a need for developing person-centredness in rehabilitation, both in theory and in practice. Person-centredness is a key feature in rehabilitation for people living with dementia. In rehabilitation, person-centredness may entail other principles and components than in dementia care in general. There is a need for developing person-centredness in rehabilitation, both in theory and in practice