Remote primary care consultations for people living with dementia during the COVID-19 pandemic: experiences of people living with dementia and their carers

BACKGROUND: COVID-19 has accelerated remote healthcare provision in primary care, with changes potentially permanent. The implementation of remote provision of healthcare needs to hear from vulnerable populations, such as people living with dementia. AIM: To understand the remote healthcare experiences of patients living with dementia and their family carers during the COVID-19 pandemic. DESIGN AND SETTING: Qualitative interviews with community-based patients living with dementia and their carers during early months (May-August 2020) of the COVID-19 pandemic in England. METHODS: Semi-structured interviews were conducted remotely by telephone or video call with 30 patients living with dementia and 31 carers. Data were analysed using thematic analysis. RESULTS: Three main themes were derived relating to: 1) proactive care at the onset of COVID-19 restrictions, 2) avoidance of healthcare settings and services, and 3) difficulties with remote healthcare encounters. People living with dementia and their carers felt check-up calls were reassuring but limited in scope and content. Some avoided healthcare services, wishing to minimise COVID-19 risk, reduce NHS burden, or encountering technological barriers. Difficulties in remote consultations included lack of prompts to remember problems, dealing with new emerging problems, rescheduling/missed calls, and inclusion of the person with dementia's voice. CONCLUSION: While remote consultations could be effective, pro-active calls could be more structured around needs, and consideration should be given to replace non-verbal prompts to describe problems, particularly for new health concerns. In continuing remote consultations, it is important to facilitate engagement with patients living with dementia and their carers to ensure best practice

Exploring how triads of people living with dementia, carers and health care professionals function in dementia health care: A systematic qualitative review and thematic synthesis

BACKGROUND: Many qualitative studies report the post-diagnostic care experiences of carers and people living with dementia; however, this is not often accompanied by opportunities to hear the corresponding views of their health care professionals and how this triadic relationship functions. The aim of this review was to identify and thematically synthesize the experiences of health care services reported by people living with dementia, their carers and health care professionals. METHODS: Medline, PsycINFO, Embase and CINAHL were searched from inception to 31 July 2019 for qualitative research including people living with dementia, carers and health care professionals. Data were coded and thematically synthesised using NVivo. RESULTS: Medline, PsycINFO, Embase and CINAHL were searched from inception to 31 July 2019 for qualitative research including people living with dementia, carers and health care professionals. Data were coded and thematically synthesised using NVivo. DISCUSSION: The interactions and complexity of triadic dementia care relationships further our understanding of how to improve dementia care. Awareness of possible diverging attitudes highlights areas of necessary improvement and further research into facilitating engagement, such as when multiple professionals are involved or where there are mismatched expectations of the roles of triad members. In order to operate efficiently as a triad member, professionals should be aware of how pre-existing relations can influence the composition of a triad, encourage the involvement of the person living with dementia, clarify the expectations of all parties, establish trusting relationships and enable communication within the direct triad and beyond

Occupational balance: What tips the scales for new students?

The open question, ‘What prevents you from reaching occupational balance?’, was posed within a questionnaire aimed at exploring the meanings of occupation, health and wellbeing with a cohort of first-year occupational therapy students during their initial few weeks at university. Their written responses to the question about occupational balance were analysed and are discussed in this paper. Not surprisingly, occupational balance appeared to be achieved by only a few and more by chance than design. People, time and money factors were identified as the main impediments to achieving occupational balance, with psychological and emotional pressures being at the forefront. Interestingly, despite these barriers, the overall educational benefit of considering the occupational balance question in this way raised the students’ awareness of its relationship to health and wellbeing. This increased awareness might have longer-term health benefits, both personally and professionally, which would be worthy of further research

Effectiveness of different post-diagnostic dementia care models delivered by primary care: a systematic review

BACKGROUND: Global policy recommendations suggest a task-shifted model of post-diagnostic dementia care, moving towards primary and community-based care. It is unclear how this may best be delivered. AIM: To assess the effectiveness and cost-effectiveness of primary care-based models of post-diagnostic dementia care. DESIGN AND SETTING: A systematic review of trials and economic evaluations of post-diagnostic dementia care interventions where primary care was substantially involved in care plan decision making. METHOD: Searches were undertaken of MEDLINE, PsychINFO, EMBASE, Web of Science, and CINAHL (from inception to March 2019). Two authors independently critically appraised studies and inductively classified interventions into types of care models. Random effects meta-analysis or narrative synthesis was conducted for each model where appropriate. RESULTS: From 4506 unique references and 357 full texts, 23 papers were included from 10 trials of nine interventions, delivered in four countries. Four types of care models were identified. Primary care provider (PCP)-led care (n = 1) led to better caregiver mental health and reduced hospital and memory clinic costs compared with memory clinics. PCP-led care with specialist consulting support (n = 2) did not have additional effects on clinical outcomes or costs over usual primary care. PCP-case management partnership models (n = 6) offered the most promise, with impact on neuropsychiatric symptoms, caregiver burden, distress and mastery, and healthcare costs. Integrated primary care memory clinics (n = 1) had limited evidence for improved quality of life and cost-effectiveness compared with memory clinics. CONCLUSION: Partnership models may impact on some clinical outcomes and healthcare costs. More rigorous evaluation of promising primary care-led care models is needed

Visual recognition of gestures in a meeting to detect when documents being talked about are missing

Meetings frequently involve discussion of documents and can be significantly affected if a document is absent. An agent system capable of spontaneously retrieving a document at the point it is needed would have to judge whether a meeting is talking about a particular document and whether that document is already present. We report the exploratory application of agent techniques for making these two judgements. To obtain examples from which an agent system can learn, we first conducted a study of participants making these judgements with video recordings of meetings. We then show that interactions between hands and paper documents in meetings can be used to recognise when a document being talked about is not to hand. The work demonstrates the potential for multimodal agent systems using these techniques to learn to perform specific, discourse-level tasks during meetings

Being well, being musical: Music composition as a resource and occupation for older people

Introduction: Participatory music making for older people has tended to focus on singing and performance. In a community music project undertaken by Manchester Camerata (a chamber orchestra), Blacon Community Trust and a small group of older adults, participants were given the opportunity to compose individual pieces of music interactively with professional musicians. This paper reports the findings of the research project. Method: An arts-based research method was adopted and incorporated action research and interpretive interactionism to articulate the experiences and perceptions of participants. Participants and Manchester Camerata musicians also worked together to represent the thematic findings of the research in a group composition. Findings: The findings demonstrate that individual and group music composition contributed to a sense of wellbeing through control over musical materials, opportunities for creativity and identity making, validation of life experience and social engagement with other participants and professional musicians. Conclusion; The results emphasised occupation as essential to health and wellbeing in the later stages of life. The findings also highlight the particularly innovative aspects of this research: (i) the use of music composition as a viable arts-in-health occupation for older people and (ii) the arts-based research method of group composition. (PsycINFO Database Record (c) 2016 APA, all rights reserved

What works in managing complex conditions in older people in primary and community care? A state‐of‐the‐art review

This is the final version. Available on open access from Wiley via the DOI in this recordThe number of older people living with complex health conditions is increasing, with the majority of these managed in primary and community settings. Many models of care have been developed to support them, however there is mixed evidence on their value and they include multiple overlapping components. We aimed to synthesise the evidence to learn what works for managing complex conditions in older people in primary and community care. We carried out a state-of-the-art review of systematic reviews. We searched three databases (Jan 2009-Jul 2019) for models of primary and community care for long-term conditions, frailty, multimorbidity and complex neurological conditions common to older people such as dementia. We narratively synthesised review findings to summarise the evidence for each model type and identify components which influenced effectiveness. Out of 2129 unique titles and abstracts, 178 full texts were reviewed and 54 systematic reviews were included. We found that models of care were more likely to improve depressive symptoms and mental health outcomes than physical health or service use outcomes. Interventions including self-management, patient education, assessment with follow-up care procedures, and structured care processes or pathways had greater evidence of effectiveness. The level of healthcare service integration appeared to be more important than inclusion of specific professional types within a team. However, more experienced and qualified nurses were associated with better outcomes. These conclusions are limited by the overlap between reviews, reliance on vote counting within some included reviews, and the quality of study reports. In conclusion, primary and community care interventions for complex conditions in older people should include: (i) clear intervention targets; (ii) explicit theoretical underpinnings; and (iii) elements of self-management and patient education, structured collaboration between healthcare professionals and professional support. Further work needs to determine the optimal intensity, length, team composition and role of technology in interventions.Alzheimer’s SocietyNIH

Implementing post diagnostic dementia care in primary care: A mixed-methods systematic review

This is the author accepted manuscript. The final version is available from Taylor & Francis via the DOI in this recordObjectives: Concentrating post-diagnostic dementia care in primary care may lead to better and more cost-effective care closer to home. We aimed to assess which intervention components and contextual factors may contribute to the successful delivery and implementation of primary care-led post-diagnostic dementia care. Methods: Mixed-methods systematic review. We searched five databases (inception-March 2019) with reference list screening and citation tracking. We included studies evaluating post-diagnostic dementia care interventions where primary care had a significant role in dementia care, which assessed one or more implementation elements (acceptability, feasibility, adoption, sustainability, reach, costs, appropriateness or fidelity). Two authors independently critically appraised studies. Results: Out of 4528 unique references, we screened 380 full texts and included 49 evaluations of services collecting implementation process data. Most services had high acceptability ratings. The most acceptable components were information provision, social and emotional support and links to community organisations. Feasibility was chiefly influenced by provider engagement and leadership, building dementia care capacity, sufficient resources/funding and collaboration. Care quality was maximised through adding capacity from a dementia-specific health professional. On the basis of limited data, costs for various primary care-led models did not substantially differ from each other. Conclusion: A range of primary care-led dementia care models appear feasible and acceptable. Future services should: add dementia-focussed health professionals into primary care, develop primary care leadership and provide sufficient funding and collaboration opportunities. Information, community service links and social and ongoing support should be part of services. Further exploration of service reach and formalised fidelity assessment are needed.Alzheimer’s SocietyNational Institute for Health Research (NIHR