Informal Caregivers of People with Dementia: Problems, Needs and Support in the Initial Stage and in Subsequent Stages of Dementia: A Questionnaire Survey

Objective: The ageing of the population is expected to lead to an increase in the prevalence of dementia. Providing support to informal caregivers is essential to promote their wellbeing and prevent serious caregiver burden. The aim of the study is to investigate whether differences occur between the initial and later stages of dementia in terms of (1) problems experienced by informal caregivers in the provision of care, (2) use of professional support by persons with dementia, (3) informal caregivers’ needs for additional professional support. Methods: The data were collected within the framework of the Dutch National Dementia Program, which was instigated in 2005 by the Dutch Ministry of Health, Welfare and Sport to improve integrated care for people with dementia and their informal caregivers. This paper is based on data of a questionnaire survey among 1494 informal caregivers, collected between September 2007 and December 2008. Results: Most informal caregivers (98-99%) experienced problems in caring for a person with dementia, irrespective of the stage of the illness process. In later stages, informal caregivers more often experienced problems in their social networks. Most dementia patients (87-94%) received ambulatory professional support. Conclusions: Since informal caregivers indicate a need for additional professional support in all stages of dementia, professional support should be provided during the entire illness process. Informal caregivers need advice on how to cope with symptoms of dementia, how to deal with behavior problems and receive more information about (early and advanced stages of) dementia and the supply of support. (aut. ref.

Das enttäuschte Versprechen der Integration: Migrantennachkommen in Frankreich und Deutschland

Dieser Beitrag beschäftigt sich mit den sozialstrukturellen Voraussetzungen, die der Dynamik bzw. dem Ausbleiben von Protestverhalten zu Grunde liegen. Ausgehend von drei theoretischen Erklärungsansätzen wird empirisch anhand von repräsentativen Mikrodaten gezeigt, dass die Konzeption der Integration der Migrantennachkommen durch die Staatsbürgerschaft und die Schule in Frankreich als ein Versprechen der Integration verstanden werden kann, das im Übergang auf den Arbeitsmarkt strukturell enttäuscht wird. Demgegenüber setzt die Ausgrenzung von Migrantennachkommen in Deutschland schon im Bildungssystem ein, so dass größere Erwartungshaltungen gar nicht erst entstehen. Die Revolten der jungen MigrantInnen in Frankreich können damit u.a. als Ergebnis von strukturell enttäuschten Erwartungen interpretiert werden.Integration, Zweite Generation, Migration, Deutschland, Frankreich

End-of-life hospital referrals by out-of-hours general practitioners: a retrospective chart study

<p>Abstract</p> <p>Background</p> <p>Many patients are transferred from home to hospital during the final phase of life and the majority die in hospital. The aim of the study is to explore hospital referrals of palliative care patients for whom an out-of-hours general practitioner was called.</p> <p>Methods</p> <p>A retrospective descriptive chart study was conducted covering a one-year period (1/Nov/2005 to 1/Nov/2006) in all eight out-of-hours GP co-operatives in the Amsterdam region (Netherlands). All symptoms, sociodemographic and medical characteristics were recorded in 529 charts for palliative care patients. Multivariate logistic regression analysis was performed to identify the variables associated with hospital referrals at the end of life.</p> <p>Results</p> <p>In all, 13% of all palliative care patients for whom an out-of-hours general practitioner was called were referred to hospital. Palliative care patients with cancer (OR 5,1), cardiovascular problems (OR 8,3), digestive problems (OR 2,5) and endocrine, metabolic and nutritional (EMN) problems (OR 2,5) had a significantly higher chance of being referred. Patients receiving professional nursing care (OR 0,2) and patients for whom their own general practitioner had transferred information to the out-of-hours cooperative (OR 0,4) had a significantly lower chance of hospital referral. The most frequent reasons for hospital referral, as noted by the out-of-hours general practitioner, were digestive (30%), EMN (19%) and respiratory (17%) problems.</p> <p>Conclusion</p> <p>Whilst acknowledging that an out-of-hours hospital referral can be the most desirable option in some situations, this study provides suggestions for avoiding undesirable hospital referrals by out-of-hours general practitioners at the end of life. These include anticipating digestive, EMN, respiratory and cardiovascular symptoms in palliative care patients.</p

A passive Stokes flow rectifier for Newtonian fluids

Non-linear effects of the Navier-Stokes equations disappear under the Stokes regime of Newtonian fluid flows disallowing the fluid flow rectification. Here we show mathematically and experimentally that passive flow rectification of Newtonian fluids is obtainable under the Stokes regime of both compressible and incompressible flows by introducing nonlinearity into the otherwise linear Stokes equations. Asymmetric flow resistances arise in shallow nozzle/diffuser microchannels with deformable ceiling, in which the fluid flow is governed by a non-linear coupled fluid-solid mechanics equation. Fluid flow rectification has been demonstrated for low-Reynolds-number flows (Re ~ O(0.001)-O(1)) of common Newtonian fluids such as air, water, and alcohol. This mechanism can pave the way for regulating the low-Reynolds-number fluid flows with potential applications in precise low-flow-rate micropumps, drug delivery systems, etc

Measuring positive caregiving experiences in family caregivers of nursing home residents: a comparison of the Positive Experiences Scale, Gain in Alzheimer Care INstrument, and Positive Aspects of Caregiving questionnaire

Aim To compare the Positive Experiences Scale (PES), Gain in Alzheimer Care INstrument (GAIN) and Positive Aspects of Caregiving (PAC) in assessing positive caregiving experiences among caregivers of nursing home residents with dementia, and to explore which caregiver and care recipient characteristics relate to positive caregiving experiences.Methods A total of 63 caregivers (mean age 59.2 years; SD 11.8) of nursing home residents with dementia from four Dutch nursing homes participated in this cross-sectional observational study. Internal consistency, convergent validity and user-friendliness (i.e. perception of item relevance and comprehensibility, ease of use, missing items, and user preference) were examined using Cronbach's alpha's, correlation coefficients and descriptive statistics, respectively.Results The Cronbach's alpha for the GAIN, PAC and PES was 0.90, 0.94 and 0.68, respectively. The sum score of the PES showed a ceiling effect. Convergent validity was confirmed for all three instruments. The PES had the least missing data (mean number of missing items 0.2, SD 0.5) and was preferred by 40% of the caregivers, followed by the GAIN (mean number of missing items 0.6, SD 1.7, preferred by 11%). Positive caregiving experiences were negatively associated with educational level (range -0.28 to -0.35). Only the PES correlated positively with caregiver age (r = 0.25).Conclusions All three questionnaires can be used to assess positive caregiving experiences, but the GAIN might be the most suitable questionnaire for caregivers of nursing home residents with dementia. Further research is necessary to examine generalizability of the findings. Geriatr Gerontol Int 2021; center dot center dot: center dot center dot-center dot center dot.Geriatrics in primary carePublic Health and primary car