How can autonomy be maintained and informal care improved for people with dementia living in residential care facilities: A systematic literature review

Background and objectives: For people with dementia living in residential care facilities, maintaining autonomy and receiving informal care are important. The objective of this review is to understand how caregiving approaches and physical environment, including technologies contribute to the maintenance of autonomy and informal care provision for this population. Research design and method: A literature review of peer-reviewed articles published between January 1995 and July 2017 was performed. Realist logic of analysis was used, involving context, mechanism and outcome configurations. Results: Forty-nine articles were included. The improvement of the relationship between residents and formal/informal caregivers is important. This increases the knowledge (sharing) about the resident and contributes to their autonomy. A social, flexible, and welcoming attitude of the formal caregiver improves the provision of informal care. Specially designed spaces, for instance, therapeutic gardens, create activities for residents that remind them of themselves and contribute to their autonomy. Use of technologies reduces caregiver's time for primary tasks and therefore enables secondary tasks such as interaction with the residents. Discussion and implications: The results revealed how residential care facilities could maintain autonomy of their residents and improve informal care delivery using caregiving approaches and the physical environment including technologies. The results are supporting toward each other in maintaining autonomy and also helped in enhancing informal care provision. For residential care facilities that want to maintain the autonomy of their residents and improve informal care delivery, it is important to pay attention to all aspects of living in a residential care facility

Perspectives of stakeholders on technology use in the care of community-living older adults with dementia:A systematic literature review

Although technology has the potential to promote aging in place, the use of technology remains scarce among community-living older adults with dementia. A reason might be that many stakeholders are involved who all have a different perspective on technology use (i.e., needs, wishes, attitudes, possibilities, and difficulties). We systematically searched the literature in order to provide an overview of perspectives of different stakeholders on technology use among community-living older adults with dementia. After selection, 46 studies were included. We mainly found perspectives of informal caregivers and, to a lesser extent, of persons with dementia and formal caregivers. Perspectives of suppliers of technology were not present. Shared perspectives among persons with dementia and informal and formal caregivers were, among other things, ease of use, stability and flexibility of technology, importance of privacy, and confidentiality. We also found that among older persons, fun and pleasure, in addition to enhancing freedom and independence, facilitates technology use. Informal caregivers' peace of mind and relief of burden also appeared to be important in using technologies. Formal caregivers value the potential of technologies to improve monitoring and communication. Insight in shared, and conflicting perspectives of stakeholders are essential to enhance the use of technolog

Diversiteit in internetgebruik door Nederlandse ouderen:Een latente klasseanalyse

Doelstelling: In Nederland maken steeds meer ouderen gebruik van internet. Eerder onderzoek richt zich vooral op de vraag waarom de ene oudere wel online gaat en de andere niet. Er is echter weinig onderzoek gedaan naar de doelen waarvoor ouderen internet gebruiken. Dit artikel wil het inzicht in de activiteiten van internettende ouderen vergroten: hoe divers is hun internetgebruik, en zijn er verschillende subgroepen van ouderen te onderscheiden? Methoden: We hebben data gebruikt van het Longitudinal Internet Studies for the Social Sciences-panel, een representatief internetpanel van de Nederlandse bevolking. Respondenten van 65 jaar en ouder die internet gebruiken (n = 1.418) werden geselecteerd. Vervolgens is een latente klasseanalyse uitgevoerd op basis van de activiteiten waarvoor ouderen internet gebruiken.Resultaten: In de groep ouderen die internet gebruikten onderscheiden we vier clusters. Allereerst de cluster van ‘praktische gebruikers’, ouderen die internet voornamelijk gebruikten voor praktische en financiële doelen, zoals het opzoeken van informatie, vergelijken van producten en internetbankieren. Tot cluster 2 behoren ‘minimale gebruikers’, die de minste tijd spendeerden op internet, internet voor slechts weinig doeleinden gebruikten en gemiddeld ouder waren (>73 jaar). Cluster 3 betreft de ‘maximale gebruikers’, die internet gebruikten voor verscheidene activiteiten, veel tijd aan internet besteedden en relatief jonger waren (<70 jaar). Tot slot cluster 4, de ‘sociale gebruikers’, die internet vooral gebruikten voor amusement en sociale activiteiten, zoals gamen en het bezoeken van socialenetwerksites. De clusters verschillen significant in leeftijd, in tijd die de ouderen op internet doorbrachten en de frequentie waarmee ouderen apps downloadden. De minimale gebruikers scoorden iets lager op psychisch welbevinden, iADL en ervaren gezondheid vergeleken met de praktische en maximale gebruikers. Conclusie: Ouderen die internet gebruiken vormen een diverse groep. Het voldoet daarom niet om louter onderscheid te maken tussen ouderen die internet wel gebruiken en ouderen die dat niet doen. De clusters die we onderscheiden kunnen gebruikt worden bij het ontwikkelen en implementeren van e‑health-interventies bij ouderen

Diversity in older adults’ use of the internet: Identifying subgroups through latent class analysis

Background: As for all individuals, the Internet is important in the everyday life of older adults. Research on older adults’ use of the Internet has merely focused on users versus nonusers and consequences of Internet use and nonuse. Older adults are a heterogeneous group, which may implicate that their use of the Internet is diverse as well. Older adults can use the Internet for different activities, and this usage can be of influence on benefits the Internet can have for them. Objective: The aim of this paper was to describe the diversity or heterogeneity in the activities for which older adults use the Internet and determine whether diversity is related to social or health-related variables. Methods: We used data of a national representative Internet panel in the Netherlands. Panel members aged 65 years and older and who have access to and use the Internet were selected (N=1418). We conducted a latent class analysis based on the Internet activities that panel members reported to spend time on. Second, we described the identified clusters with descriptive statistics and compared the clusters using analysis of variance (ANOVA) and chi-square tests. Results: Four clusters were distinguished. Cluster 1 was labeled as the “practical users” (36.88%, n=523). These respondents mainly used the Internet for practical and financial purposes such as searching for information, comparing products, and banking. Respondents in Cluster 2, the “minimizers” (32.23%, n=457), reported lowest frequency on most Internet activities, are older (mean age 73 years), and spent the smallest time on the Internet. Cluster 3 was labeled as the “maximizers” (17.77%, n=252); these respondents used the Internet for various activities, spent most time on the Internet, and were relatively younger (mean age below 70 years). Respondents in Cluster 4, the “social users,” mainly used the Internet for social and leisure-related activities such as gaming and social network sites. The identified clusters significantly differed in age (P<.001, ω2=0.07), time spent on the Internet (P<.001, ω2=0.12), and frequency of downloading apps (P<.001, ω2=0.14), with medium to large effect sizes. Social and health-related variables were significantly different between the clusters, except social and emotional loneliness. However, effect sizes were small. The minimizers scored significantly lower on psychological well-being, instrumental activities of daily living (iADL), and experienced health compared with the practical users and maximizers. Conclusions: Older adults are a diverse group in terms of their activities on the Internet. This underlines the importance to look beyond use versus nonuse when studying older adults’ Internet use. The clusters we have identified in this study can help tailor the development and deployment of eHealth intervention to specific segments of the older population

Experienced and anticipated discrimination reported by individuals in treatment for substance use disorders within the Netherlands

Experiences and expectations of discrimination (anticipated discrimination) may delay treatment seeking among people with substance use disorders. In addition, experienced and anticipated discrimination can be a barrier to successful recovery and rehabilitation. The aim of this study was to study the level of experienced and anticipated (the expectation to be rejected) discrimination among individuals in treatment for substance use disorders as well as the association between both concepts of discrimination. In addition, the association of experienced and anticipated discrimination with clinical and social characteristics was investigated. A cross-sectional survey among individuals in treatment for substance use disorders in the Netherlands was carried out in 2012. Individuals in treatment (N = 186) completed a self-reported questionnaire about experienced and anticipated discrimination. Descriptive statistics and chi-squared analyses were performed to investigate the level of experienced and anticipated discrimination and the association between both concepts. Linear regression analyses were used to investigate the association with clinical and social characteristics, such as occupational status and type of treatment. Individuals in treatment for substance use disorders reported high levels of experienced and anticipated discrimination. Respondents experienced most discrimination in family ties, intimate relationships and friendships. Experienced and anticipated discrimination were both positively correlated. Having complex substance use problems and a longer history of substance use problems was related to higher levels of experienced discrimination. In conclusion, experienced and anticipated discrimination were highly prevalent among individuals in treatment for substance use disorders. Attention in addiction treatment for adequate coping with discrimination may be needed in order to achieve successful social participation and rehabilitation of these individuals

Healthcare professionals’ regard toward working with patients with substance use disorders: Comparison of primary care, general psychiatry and specialist addiction services

Background Healthcare professionals are crucial in access to treatment for patients with substance use disorders. However, healthcare professionals often have negative attitudes towards this patient group. Healthcare professionals’ regard for working with patients with substance use disorders was examined and three sectors in which professionals are working were compared. Methods General practitioners (GPs; N = 180), healthcare professionals of general psychiatry (N = 89) and specialists in addiction services (N = 78) filled out a questionnaire in which regard for working with patients with substance use disorders was assessed. ANOVAs were used to compare the sectors and multiple linear regression analysis tested the association of regard with attribution beliefs, emotional reactions and other characteristics of healthcare professionals. Results Regard for working with patients with substance use disorders was different between the three sectors (GPs M = 42.00; general psychiatry M = 48.18; addiction specialists M = 55.41; p = 0.00, ω2 = 0.40). Attribution of personal responsibility and feeling of anger and fear were associated with lower regard scores. More familiarity with substance use problems, higher frequency of working with this patients group and more confidence in substance abuse treatment were positively associated with regard. Social desirability bias was present and was positively related to healthcare professionals’ regard. Conclusions Health care professionals of specialist addiction services showed higher regard for working with patients with substance use disorders compared to professionals of general psychiatry services and GPs. Improvement of education and shared care models in which healthcare professionals are supported by professionals specializing in addiction might address low regard. Keywords: Substance-related disorders, Attitude of health personnel, Stigma, Medical condition regard scale, Cross-sectional stud