Facilitating social coping-‘seeking emotional and practical support from others’-as a critical strategy in maintaining the family care of people with dementia

The aim of this study was to identify how the family care of people living with dementia could be supported to make reliance on family care sustainable in the long term despite the impact of stress. A Realist Evaluation (Pawson & Tilley, 1997) was conducted to investigate this aim. An initial review established ‘coping’ as a primary means of mediating stressors associated with caregiving. However, there was a need to specify which coping approaches/strategies are most effective. In-depth interviews were conducted with a purposive sample of family carers (n = 18) in a suburb in North East England from 2016 to 2017. Analysis of the data revealed ‘social coping’ (SC) that included an emotional support component as a critical mediator of family carer stress. Several key hindrances to the utilisation of SC, including underpinning causal factors, are explicated. Ways in which these hindrances might be overcome are discussed and guidelines introduced for how family carers, formal providers and practitioners can facilitate SC as a critical coping strategy in sustaining the family care of people with dementia over the long term

Exploring medicines reconciliation in the emergency assessment unit: staff perceptions and actual waiting times

Background Medicines reconciliation is the process of creating and maintaining the most accurate list possible of all medicines a patient is taking. If medicines reconciliation cannot be completed in a timely manner in hospital emergency assessment units (EAUs), delays in treatment can occur, potentially leading to deterioration of long-term and acute conditions, patient distress and complaints. Aim To obtain the perspectives of staff working on an EAU regarding the time patients wait for their medicines to be prescribed, including their awareness of practice and protocols. To determine the time from admission to the EAU until medicines reconciliation, and to identify if there was any time difference in medicines reconciliation according to the day of admission. Method This was a service evaluation in which staff working in one EAU in a teaching hospital in the north east of England were asked to complete a survey in December 2017. The staff survey aimed to ascertain: whether staff were aware of any guidance relating to medicines reconciliation times; how long they thought the average waiting time was for medicines reconciliation; and if they thought there were implications for patients or staff as a result of time spent waiting for medicines reconciliation. In addition, an audit was performed analysing medicines reconciliation times for all patients admitted to the EAU during the month of December 2017. Results A total of 30 staff members responded to the survey. While 40% (n=12) of respondents believed that the EAU had an efficient system in place for timely medicines reconciliation, 90% (n=27) believed the unit could still improve. Almost half the respondents (47%, n=14) perceived a delay in medicines reconciliation could result in exacerbation of patients’ physical conditions. The clinical audit identified considerable variation in medicines reconciliation times, ranging from seven minutes to almost 24 hours. However, most medicines (82%) were reconciled within six hours. Conclusion This service evaluation found that the median time after arrival in the EAU until completion of medicines reconciliation was two hours 48 minutes. However, almost one fifth of patients had to wait for more than six hours, and in one instance almost 24 hours. One potential solution could be increasing the involvement of hospital pharmacists or pharmacy technicians in medicines reconciliation

Alzheimer's Disease: The Resilience Approach to making the Family Care of People Living with Alzheimer's sustainable

With critical reliance on primary family carers of people living with Alzheimer’s disease (PWA) at an all-time high and set to increase markedly over the next few decades an urgent question concerns how this growing army of family carers will be supported in the future? The uniqueness and complexity of Alzheimer’s disease (AD) compared with other diseases and the myriad challenges it presents for family carers make such carers particularly vulnerable to the debilitating effects of chronic stress and its sequelae. The biopsychosocial pathways responsible for carer health deficits resulting from chronic exposure to the care environment are discussed. Further, a new epidemiological framework is introduced that attempts to capture how the dynamics at work within the AD care environment might lead it to become epidemiological in the sense that chronic exposure to it can uniquely generate carer disease outcomes. If the family care of PWA can potentially create an environment and dynamics within this that may be injurious to carers themselves, leading to premature cessation of informal care, a central issue for policy-makers and service providers concerns ‘who will care for the carers and how?’ Although the present article primarily focuses on family carers of PWA, the knowledge that carers’ health has a relatively direct impact on the capacity to carry out caregiving, as well as influencing the levels of harmony or disequilibrium that exists within the care environment, crucially means that carers’ health also impacts on the wellbeing of PWA as part of a closely knit reciprocal relationship-they are mutually bound. Further, while there is evidence to indicate that some family carers of PWA appear able to overcome the many challenges and potential attrition long-term care of a PWA can inflict on their own health, a further key question concerns how such carers manage despite adversity? What characteristics, assets and resources do these carers possess that perhaps sets them apart? Are there valuable lessons we can learn concerning how the family care of PWA might be made optimal while safeguarding family carers’ own health? This represents an important question since the vast majority of family carers, and moreover their care recipients, hope and desire to spend their final years, months, days together as a family rather than see their family member consigned to a formal institution. This article therefore argues the case for urgent public health action against the backdrop of the rising tide of AD globally. Presently, there is a lack of any clear consensus concerning how more productive care environments might be created that better safeguard both family carers’ health and by association PWA’s health. Moreover, there is a need to move beyond syntheses of findings from the available literature that are limited to descriptive accounts based on ‘outcomes’ and towards a deeper analysis of ‘process,’ i.e. by focusing on what intrinsically ‘works’ to support family carers of PWA and how these processes might be generated. In response, the present authors recently conducted a comprehensive Realist review of the current literature. How this review was conducted is briefly described, as are the broad findings that lead to the proposal of a new model of family care of PWA. The strengths and weaknesses of existing hypotheses are discussed for how carers can counteract the challenges to their own health that care of PWA can bring and a new hypothesis is proposed based on a Resilience approach to family care of PWA that links with humans’ ‘fight or flight’ response to stressors

Living with uncertainty: Mapping the transition from pre-diagnosis to a diagnosis of dementia

Across the world, an early and timely diagnosis of dementia is seen to be a policy and practice imperative and a necessary step in order to live well with the condition. However, limited understanding exists regarding the personal and relational meanings attributed to the diagnostic experience. Drawn from the findings of a larger multi-site study conducted in four areas of England, this article presents a subset of the data where five participants and their carers and two people living alone initially presented themselves at a memory clinic for diagnostic testing, with this presentation eventually resulting in a confirmed, and shared, diagnosis of dementia. All 12 participants were interviewed at two time points in the study: at the time of first presentation to the memory clinic and shortly after the diagnosis had been shared with them. Informed by the grounded theory method, constant comparative analysis was applied to the data and this process resulted in a four-phase sequential model of diagnostic transition: (1) becoming self-aware → seeking outside help; (2) being referred → receiving a clinic appointment; (3) undergoing tests → being told what's wrong; and (4) adjusting to the diagnosis → negotiating everyday expectations. Running through each phase was the core category of ‘living with uncertainty’ which summarised the entire diagnostic journey for all study participants. Findings suggest a need for better awareness and information for people living with dementia at all phases and time points in the condition, which may be fostered by embedding these in early clinical encounters

Patient Centred Care and Vulnerability in Old Age

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

How do we provide good mealtime care for people with dementia living in care homes? A systematic review of carer-resident interactions

People with dementia who live in care homes often depend on care home staff for help with eating and drinking. It is essential that care home staff have the skills and support they need to provide good care at mealtimes. Good mealtime care may improve quality of life for residents, and reduce hospital admissions. The aim of this systematic review was to identify good practice in mealtime care for people with dementia living in care homes, by focusing on carer-resident interactions at mealtimes. Robust systematic review methods were followed. Seven databases were searched: AgeLine, BNI, CENTRAL, CINAHL, MEDLINE, PsycINFO and Web of Science. Titles, abstracts, and full texts were screened independently by two reviewers, and study quality was assessed with Joanna Briggs Institute tools. Narrative synthesis was used to analyse quantitative and qualitative evidence in parallel. Data were interrogated to identify thematic categories of carer-resident interaction. The synthesis process was undertaken by one reviewer, and discussed throughout with other reviewers for cross-checking. After title/abstract and full-text screening, 18 studies were included. Some studies assessed mealtime care interventions, others investigated factors contributing to oral intake, whilst others explored the mealtime experience. The synthesis identified four categories of carer-resident interaction important to mealtime care: Social connection, Tailored care, Empowering the resident, and Responding to food refusal. Each of the categories has echoes in related literature, and provides promising directions for future research. They merit further consideration, as new interventions are developed to improve mealtime care for this population