Consequences of clinical case management for caregivers a systematic review

International audienceObjective Informal caregivers are deeply involved in the case management process. However, little is known about the consequences of such programs for informal caregivers. This systematic literature review, reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, addressed the consequences of clinical case management programs, whether positive or negative, for caregivers of frail older persons or persons with dementia.Methods We systematically identified and analyzed published randomized trials and quasi-experimental studies comparing case management programs to usual care, which discussed outcomes concerning caregivers.Results Sixteen studies were identified, and 12 were included after quality assessment. Seven identified at least one positive result for caregivers, and no negative effect of case management has been found. Characteristics associated with positive results for caregivers were a high intensity of case management and programs specifically addressed to dementia patients.Conclusions Despite the numerous methodological challenges in the assessment of such complex social interventions, our results show that case management programs can be beneficial for caregivers of dementia patients and that positive results for patients are achieved without increasing caregivers' burden

Dementia: Introduction, Epidemiology and Economic Impact

Dementia is a syndrome of progressive cognitive and functional impairment. It is caused by one or more neurodegenerative diseases, the most common of which are Alzheimer’s disease (AD) and cerebrovascular disease (leading to vascular dementia). People with dementia suffer from diverse impairments and symptoms that affect them in different ways depending on dementia subtype and their personal and social circumstances. Memory is characteristically affected in Alzheimer’s disease, but other dementias may present with behavioural or mood changes, communication or perceptual difficulties. Dementia onset may be sudden or it may be preceded by a stage of sub-dementia cognitive deficits, often termed mild cognitive impairment. Cost-of-illness studies aim to assess the economic burden of a disease and highlight the impact of the disease on society and provide important knowledge and guidance to decision-makers in prioritising their decisions regarding healthcare and prevention policies. There is increasing interest in examining the costs of dementia, and yearly reports are published regarding the worldwide cost. These reports synthesise the knowledge emerging from the studies assessing the cost of the disease in individual countries and show that, geographically, the majority of the studies are conducted in high-income countries, with 70 % being conducted in Western countries, mainly Europe and North America. More studies need to be conducted in low-income countries, because the prevalence of dementia in such countries is expected to significantly increase

Closing care gaps after hospitalization: Study results [intersec-CM] on discharge and transfer management according to sect. 39 SGB V for people with cognitive impairments associated with dementia

Schumacher-Schonert F, Boekholt M, Nikelski A, et al. Versorgungslücken nach dem Krankenhausaufenthalt schließen: Studienergebnisse [intersec-CM] zum Entlass- und Überleitungsmanagement nach § 39 SGB V für Menschen, die im Krankenhaus kognitive demenzielle Beeinträchtigungen zeigen. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen. 2024.In Germany, there are 1.8 million people currently living with dementia, and the trend is rising. In particular, the health system at the transition from hospital to outpatient care is facing major challenges given the high increase in a difficult patient clientele. Legal efforts have been undertaken (sect. 39a of the Fifth Social Code Book [SGB V]) to close the care gaps in the discharge and transfer process. This article aims to provide an overview of the documentation process of the discharge and transfer management for people with cognitive impairments in everyday clinical practice according to SGB V sect. 39 para. 1a after the Discharge Management Act came into force. Furthermore, the manuscript answers the research question "How is the statutory discharge management of people with cognitive impairments (MmkB) aged 65 and over documented" and highlights further characteristics of the discharge documentation for MmkB starting with the transition from the inpatient setting to other care settings. In order to answer the research question(s), a qualitative content analysis of all discharge documents available at the time of discharge was carried out as part of the intervention study on cross-sector care management to support cognitively impaired people during and after a hospital stay [intersec-CM], which was funded by the Federal Ministry of Education and Research. The results of the analysis show that, despite legal efforts, there are currently no standardized, unified processes of discharge management for people with cognitive impairments that can be traced in writing. However, departments with a large proportion of vulnerable patient groups were able to offer valuable insights: for example, their discharge documents included a short social history. Further evidence-based research and development in the domain of discharge management for people with cognitive impairments remains essential. Copyright © 2024. Published by Elsevier GmbH

"You have to take it that way." A study of the subjective experience of the corona pandemic by older people in need of help and care living at home

Nikelski A, Trompetter E, Feldmann S, et al. „Das muss man so nehmen.“ Eine Studie zum subjektiven Erleben der Coronapandemie älterer hilfe- und pflegebedürftiger Menschen in der Häuslichkeit. Zeitschrift für Gerontologie und Geriatrie. 2021;54:359–364.Background As older people are at increased risk of severe and fatal courses of SARS-CoV-2 infection, they receive special attention, which, however, often refers one-sidedly to their need for protection. What is needed is a discussion that considers the subjective reality and resources as well as risks. Objective The study focused on the perspectives of older people. The aim was to shed light on their subjective experience of the corona pandemic. The questions were how they experienced the pandemic, the risks, consequences and protective measures, to what extent these affected their everyday life and how they dealt with it. Material and methods A total of 12 guideline-based telephone interviews were conducted in May and June 2020 with 9 women and 3 men between 77 and 91 years of age, who lived in their own homes, had impaired health and needed help and care. The data were evaluated by structuring content analysis. Results The respondents were generally concerned about the corona pandemic but considered their own risk to be low. They saw themselves as hardly affected by the immediate consequences of the crisis or severely restricted in their everyday lives. They experienced insecurity in social life and fear of loneliness was central. Overall, they considered the protective measures to be appropriate but criticized early cancelling, family contact restrictions and dealing with the dying. Conclusion A moderate degree of direct personal involvement, acceptance and adaptability characterized the experience and handling of the corona pandemic. Resources and skills in dealing with the crisis become visible

Everyday Life and Mental Health of Elderly with Cognitive Impairment During the Covid-19 Pandemic

Nikelski A, Trompetter EM, Boekholt M, et al. Lebensalltag und psychosoziale Gesundheit älterer Menschen mit kognitiven Beeinträchtigungen während der COVID-19-Pandemie. Psychiatrische Praxis. 2024.OBJECTIVE: The aim is to analyze pandemic-related effects on everyday life and psychosocial health in the understudied vulnerable group of cognitively impaired elderly people living at home.; METHODS: Structured telephone interviews in 2020 (n+=+141) and 2021 (n+=+107) were used to survey over-65s with cognitive impairment (MMSE O 23.4). The results from the 2021 survey presented here reflect experiences and attitudes, effects on daily life and health care, and psychosocial burdens and resources. Longitudinal analysis of selected indicators of burden is provided for n+=+66.; RESULTS: Even in the face of increasing concerns and moderate impacts on everyday life and health care, overall psychosocial health is proving to be good and largely stable over time.; CONCLUSION: Respondents have high levels of personal and social resources, and their coping with limitations is characterized by acceptance and willingness to adapt. Thieme. All rights reserved.Ziel Ziel ist die Analyse pandemiebedingter Auswirkungen auf den Alltag und die psychosoziale Gesundheit der bislang wenig untersuchten vulnerablen Gruppe zu Hause lebender, kognitiv beeinträchtigter älterer Menschen. Methodik Mittels strukturierter Telefoninterviews 2020 (n+=+141) und 2021 (n+=+107) wurden über 65-Jährige mit kognitiven Beeinträchtigungen (MMSE Ø 23,4) befragt. Die hier vorgestellten Ergebnisse aus 2021 reflektieren Erfahrungen und Einstellungen, Auswirkungen auf den Alltag und die Versorgung sowie psychosoziale Belastungen und Ressourcen. Für n+=+66 erfolgt eine längsschnittliche Analyse ausgewählter Belastungsindikatoren. Ergebnisse Auch in Anbetracht moderater Auswirkungen auf den Alltag und die Versorgung und zunehmender Sorgen erweist sich die psychosoziale Gesundheit insgesamt als gut und im zeitlichen Verlauf als relativ stabil. Schlussfolgerung Die Befragten verfügen über ein hohes Maß an personalen und sozialen Ressourcen und ihr Umgang mit Einschränkungen ist durch Akzeptanz und Anpassungsbereitschaft gekennzeichnet