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BackgroundIn health care, the use of physical parameters to monitor physical disease progress is common. In mental health care, the periodic measurement of a client’s functioning during treatment, or routine outcome monitoring, has recently become important. Online delivery of questionnaires has the potential to reduce clinicians’ resistance to the implementation of routine outcome monitoring. Online delivery enables clinicians to receive results on a questionnaire in a graphic directly after data entry. This gives them insight into the progress of a client at a single glance. ObjectiveTo explore clinicians’ perspectives on a routine outcome monitoring procedure where questionnaires and feedback on scores were delivered online. Questionnaires could also be filled out on paper and then entered into the online system by a research assistant. MethodsIn 2009 we sent an online survey, consisting of five yes-or-no questions and six open-ended questions, to all clinicians in the 14 mental health care organizations working with the routine outcome monitoring system in the Netherlands. Of the 172 clinicians contacted, 80 (47%) opened the link and 70 of these 80 (88%) clinicians completed the survey. ResultsClinicians seldom used the graphical feedback from the Web-based system, which indicates that direct feedback on scores did not enhance the implementation of routine outcome monitoring. Integration into the electronic patient record and more training on interpretation and implementation of feedback in daily practice were seen as the primary points for further improvement. It was mainly the availability of a research assistant that made the routine outcome monitoring procedure feasible. ConclusionsWithout a research assistant and training in the interpretation of outcomes, software programs alone cannot ensure effective implementation of monitoring activities in everyday practice.

BackgroundDementia has a huge physical, psychological, social and economic impact upon caregivers, families and societies at large. There has been a growing impetus to utilize Internet interventions given the potential scalability, and presumed cost-effectiveness and accessibility. In this paper, we describe the design of a randomized controlled trial (RCT) aiming to study the impact of online self-help programs on caregivers of people with dementia in India. The experimental group will receive an interactive training and support program and the comparison group will receive an education-only e-book. It will be among the first online support intervention RCTs for a mental health condition in a lower-middle income country.Methods and designTwo hundred and eight participants are expected to be recruited via several strategies (email, Internet and social media, telephone and face-to-face) starting in the Bangalore region of India. The inclusion criteria for participation in the trial are: (1) being 18 years or older, (2) being a self-reported caregiver of a person with dementia, (3) self-report that a family member has a diagnosis of dementia (AD8 ≥ 2), and experience caregiver distress (≥ 4 on a 1-item burden scale ranging from 1 to 10 or ≥ 4 or

Introduction: People with dementia are more likely than people without dementia to be hospitalized and to experience in-hospital preventable adverse events, such as falls, skin injury, and infection, compared to other hospitalized groups. Negative attitudes towards people with dementia are common among acute healthcare workers and have been linked to a cascade of negative adverse events in this population. However, no qualitative systematic review has ever been conducted to synthesize the existing evidence in this area, which hampers the development of preventative measures. Aim: This is a protocol for a qualitative systematic review aimed at exploring and synthesizing existing qualitative evidence regarding the attitudes of nursing staff towards the prevention of adverse events among hospitalized people with dementia. Methods: Literature searches will be performed in PubMed, CINAHL, PsycINFO, Web of Science, Biblioteca Virtual de Salud, Scopus, The Cochrane Library, and Google Scholar. The references of eligible studies will be checked for eligibility. All primary qualitative or mixed-methods studies with a qualitative component published in peer-reviewed academic journals in English, Portuguese, or Spanish will be eligible. There will be no limitations to the date of publication. The selection process will be conducted independently by two researchers using the software Rayyan and then compared and discussed. Any disagreements regarding eligibility will be discussed among the entire research team and resolved via consensus. Methodological quality will be assessed using Cochrane's guidance. A meta-aggregative approach will be employed to extract and synthesize the evidence using the software package QARI from the JBI. The confidence in the findings will be graded using ConQual. Implications: This review will help identify and better understand specific attitudinal and psychosocial aspects that influence nursing care delivery for people with dementia in hospital settings. Such data can be used to generate novel explanatory models of nursing behaviors in dementia care, as well as capacity building and training to enhance hospital care for people with dementia globally. [ABSTRACT FROM AUTHOR]

The number of studies on psychological treatments of depression in older adults has increased considerably in the past years. Therefore, we conducted an updated meta-analysis of these studies. A total of 44 studies comparing psychotherapies to control groups, other therapies or pharmacotherapy could be included. The overall effect size indicating the difference between psychotherapy and control groups was g=0.64 (95% CI: 0.47-0.80), which corresponds with a NNT of 3. These effects were maintained at 6 months or longer post randomization (g=0.27; 95%CI: 0.16-0.37). Specific types of psychotherapies that were found to be effective included cognitive behavior therapy (g=0.45; 95% CI: 0.29-0.60), life review therapy (g=0.59; 95% CI: 0.36-0.82) and problem-solving therapy (g=0.46; 95% CI: 0.18-0.74). Treatment compared to waiting list control groups resulted in larger effect sizes than treatments compared to care-as-usual and other control groups (p

Objective: Not only care professionals are responsible for the quality of care but other stakeholders including regulators also play a role. Over the last decades, countries have increasingly invested in regulation of Long-Term Care (LTC) for older persons, raising the question of how regulation should be put into practice to guarantee or improve the quality of care. This scoping review aims to summarize the evidence on regulatory practices in LTC for older persons. It identifies empirical studies, documents the aims and findings, and describes research gaps to foster this field. Design: A literature search (in PubMed, Embase, Cinahl, APA PsycInfo and Scopus) was performed from inception up to December 12th, 2022. Thirty-one studies were included. Results: All included studies were from high-income countries, in particular Australia, the US and Northwestern Europe, and almost all focused on care provided in LTC facilities. The studies focused on different aspects of regulatory practice, including care users' experiences in collecting intelligence, impact of standards, regulatory systems and strategies, inspection activities and policies, perception and style of inspectors, perception and attitudes of inspectees and validity and reliability of inspection outcomes. Conclusion: With increasingly fragmented and networked care providers, and an increasing call for person-centred care, more flexible forms of regulatory practice in LTC are needed, organized closer to daily practice, bottom-up. We hope that this scoping review will raise awareness of the importance of regulatory practice and foster research in this field, to improve the quality of LTC for older persons, and optimize their functional ability and well-being. [ABSTRACT FROM AUTHOR]

In most countries, a fundamental shift in the focus of clinical care for older people is needed. Instead of trying to manage numerous diseases and symptoms in a disjointed fashion, the emphasis should be on interventions that optimize older people's physical and mental capacities over their life course and that enable them to do the things they value. This, in turn, requires a change in the way services are organized: there should be more integration within the health system and between health and social services. Existing organizational structures do not have to merge; rather, a wide array of service providers must work together in a more coordinated fashion. The evidence suggests that integrated health and social care for older people contributes to better health outcomes at a cost equivalent to usual care, thereby giving a better return on investment than more familiar ways of working. Moreover, older people can participate in, and contribute to, society for longer. Integration at the level of clinical care is especially important: older people should undergo comprehensive assessments with the goal of optimizing functional ability and care plans should be shared among all providers. At the health system level, integrated care requires: (i) supportive policy, plans and regulatory frameworks; (ii) workforce development; (iii) investment in information and communication technologies; and (iv) the use of pooled budgets, bundled payments and contractual incentives. However, action can be taken at all levels of health care from front-line providers through to senior leaders--everyone has a role to play. Dans la plupart des pays, un changement fondamental de priorite dans l'organisation des soins cliniques destines aux personnes agees est necessaire. Plutot que d'essayer de gerer la variete des maladies et symptomes de maniere individuelle, l'accent devrait etre mis sur les interventions qui optimisent les capacites physiques et mentales des personnes agees sur tout leur parcours de vie et qui leur permettent de continuer de realiser les activites qui comptent pour elles. Mais cela suppose de modifier le mode d'organisation des prestations, avec une meilleure integration a l'interieur du systeme de sante et entre les services de sante et d'aide sociale. Cela ne signifie pas que les structures existantes doivent fusionner, mais plutot qu'une grande diversite de prestataires doit travailler ensemble de maniere plus coordonnee. Des donnees factuelles montrent que des prestations de sante et d'aide sociale integrees entrainent de meilleurs resultats sur la sante des personnes agees que les prestations de soins habituelles, pour un cout equivalent; d'ou l'obtention d'une meilleure rentabilite des investissements comparativement aux modes de travail classiques. Elles permettent aussi aux personnes agees de s'impliquer socialement et d'apporter leurs contributions a la societe pendant plus longtemps. Une telle integration est particulierement importante au niveau des soins cliniques: des evaluations exhaustives devraient etre realisees chez les personnes agees dans une optique d'optimisation de leurs capacites fonctionnelles, et les plans de soins devraient etre communs a tous les prestataires. Au niveau du systeme de sante, l'integration des prestations necessite: (i) l'adoption de politiques, programmes et cadres reglementaires favorables; (ii) le developpement du personnel de sante; (iii) un investissement dans les technologies de l'information et de la communication; et (iv) la mise en place de budgets communs, de paiements regroupes et de mesures contractuelles incitatives. Toutefois, des actions peuvent etre entreprises a tous les niveaux d'organisation des soins de sante, depuis les prestataires de premiere ligne jusqu'aux hauts responsables--tout le monde a un role a jouer. En la mayoria de paises se necesita un cambio fundamental en el enfoque de la atencion clinica que reciben las personas mayores. En lugar de intentar gestionar numerosas enfermedades y sintomas por separado, deberia ponerse enfasis en las intervenciones que optimizan las capacidades fisicas y mentales de las personas mayores durante su vida y que les permitan hacer lo que ellos valoran. Esto, a su vez, requiere un cambio en la forma en la que se organizan los servicios: deberia haber mas integracion dentro del sistema sanitario y entre los servicios sanitarios y sociales. Las estructuras organizativas existentes no deben fusionarse, sino que el amplio conjunto de proveedores de servicios debe trabajar conjuntamente de una forma mas coordinada. Las pruebas indican que la atencion sanitaria y social integrada para las personas mayores contribuye a unos mejores resultados sanitarios a un coste equivalente a la atencion habitual. De esta forma, se obtiene una mayor rentabilidad de la inversion que la obtenida con formas de trabajar mas familiares. Ademas, las personas mayores pueden participar y contribuir en la sociedad durante mas tiempo. La integracion a nivel de la atencion clinica es especialmente importante: las personas mayores deberian someterse a asesoramiento integral con el objetivo de optimizar la capacidad funcional, y deberian compartirse los planes de atencion entre todos los proveedores. A nivel del sistema sanitario, la atencion integrada requiere: (i) politica, planes y marcos normativos de apoyo; (ii) desarrollo del personal sanitario; (iii) inversion en tecnologias de la informacion y comunicacion; y (iv) el uso de presupuestos y pagos combinados e incentivos contractuales. No obstante, esto puede realizarse en todos los niveles de la atencion sanitaria, desde los proveedores de primera linea hasta el personal directivo; todos juegan un papel., Introduction In 2015, the World Health organization (WHO) published the first World report on ageing and health. (1) This was followed in 2016 by the World Health Assembly's adoption of [...]

Problem Demand for long-term care services for older people is increasing rapidly in low- and middle-income countries. Countries need to establish national long-term care systems that are sustainable and equitable. Approach The Governments of Costa Rica and Thailand have implemented broadly comparable interventions to deploy volunteers in long-term home care. Both countries trained older volunteers from local communities to make home visits to impoverished and vulnerable older people and to facilitate access to health services and other social services. Local setting Costa Rica and Thailand are upper-middle-income countries with strong traditions of community-based health services that they are now extending into long-term care for older people. Relevant changes Between 2003 and 2013 Thailand's programme trained over 51 000 volunteers, reaching almost 800 000 older people. Between 2010 and 2016 Costa Rica established 50 community care networks, serving around 10000 people and involving over 5000 volunteers. Despite some evidence of benefits to the physical and mental health of older people and greater uptake of other services, a large burden of unmet care needs and signs of a growth of unregulated private services still exist. Lessons learnt There is scope for low- and middle-income countries to develop large-scale networks of community-based long-term care volunteers. The capacity of volunteers to enhance the quality of life of clients is affected by the local availability of care services. Volunteer care networks should be complemented by other initiatives, including training about health in later life for volunteers, and Investment in community long-term care services. Probleme La demande en services de soins de longue duree pour les personnes agees augmente rapidement dans les regions a revenu faible et intermediaire. Les pays doivent etablir des systemes nationaux qui soient perennes et equitables pour les soins de longue duree. Approche Les gouvernements du Costa Rica et de la Thailande ont lance des initiatives assez comparables pour faire intervenir des personnes benevoles dans les soins de longue duree a domicile. Dans ces deux pays, des benevoles issus des communautes locales ont ete formes pour rendre visite a des personnes agees pauvres et vulnerables et les aider a acceder aux services de sante et d'aide sociale. Environnement local Le Costa Rica et la Thailande sont des pays a revenu Intermediaire-superieur avec une tradition fortement ancree de services de sante a base communautaire, qu'ils cherchent desormais a etendre aux soins de longue duree des personnes agees. Changements significatifs Entre 2003 et 2013, le programme lance en Thailande a permis de former plus de 51 000 benevoles, qui sont intervenus aupres de quasiment 800 000 personnes agees. Entre 2010 et 2016, le Costa Rica a constitue 50 reseaux de soins communautaires, qui se sont mis au service de pres de 10 000 personnes, grace a l'implication de plus de 5 000 benevoles. Malgre de reelles repercussions positives sur la sante physique et mentale des personnes agees et leur meilleure prise en charge par d'autres services, il existe un lourd fardeau de besoins en soins non satisfaits et des signes de developpement de services prives qui ne sont pas reglementes. Lecons tirees Il est possible pour les regions a revenu faible et intermediaire de developper de larges reseaux de benevoles pour aider a la prestation de soins de longue duree a base communautaire. Mais la capacite de ces benevoles a ameliorer la qualite de vie des beneficiaires est affectee par la disponibilite locale des services de soins. La creation de reseaux de benevoles devrait etre accompagnee d'autres initiatives, notamment pour former les benevoles sur la sante du troisieme age et investir dans les services communautaires de soins de longue duree. Situacion La demanda de servicios de atencion a largo plazo para personas mayores esta aumentando rapidamente en paises con ingresos bajos y medios. Los paises necesitan establecer sistemas nacionales de atencion a largo plazo que sean sostenibles y equitativos. Enfoque Los gobiernos de Costa Rica y Tailandia han implementado intervenciones ampliamente comparables para desplegar voluntarios en la atencion domiciliaria a largo plazo. Ambos paises formaron a antiguos voluntarios de comunidades locales para realizar visitas a domicilio a personas mayores vulnerables y empobrecidas, y para facilitar el acceso a los servicios sanitarios y otros servicios sociales. Marco regional Costa Rica y Tailandia son paises con ingresos medios mas altos y con fuertes tradiciones de servicios sanitarios de ambito comunitario que actualmente estan ampliando hacia el cuidado a largo plazo de personas mayores. Cambios importantes Entre 2003 y 2013, el programa de Tailandia formo a 51 000 voluntarios y alcanzo casi 800 000 personas mayores. Entre 2010 y 2016, en Costa Rica se establecieron 50 redes de atencion comunitaria, lo que permitio servir a cerca de 10 000 personas y contar con mas de 5 000 voluntarios. A pesar de algunas pruebas sobre los beneficios en la salud mental y fisica de las personas mayores y un mayor uso de otros servicios, todavia existe una gran carga de necesidades de cuidados sin cubrir y senales de un crecimiento de servicios privados que no estan regulados. Lecciones aprendidas Los paises con ingresos bajos y medios tienen un margen para desarrollar redes a gran escala de voluntarios para realizar cuidados a largo plazo y de ambito comunitario. La capacidad de los voluntarios para mejorar la calidad de vida de los clientes se ve afectada por la disponibilidad local de los servicios de atencion. Las redes de cuidado voluntario deberian complementarse con otras iniciativas, incluyendo la formacion para voluntarios sobre la salud en las ultimas etapas de la vida y la inversion en los servicios de atencion a largo plazo de la comunidad., Introduction Long-term care refers to 'the activities undertaken by others to ensure that people with a significant ongoing loss of capacity, or who are at risk of such a loss, [...]

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Purpose: Longitudinal research in dementia has acknowledged the importance of transitions during the course of family caregiving. However, long-term adaptation to institutionalization has received little attention. This study attempts to describe caregivers' adaptation (changes in stress, well-being, and psychosocial resources) to placement up to 4 years following institutionalization. Design and Methods: Using data from the Caregiver Stress and Coping Study, this analysis constructed four longitudinal panels, each consisting of a preplacement assessment and either two (n = 146), three (n = 109), four (n = 75), or five (n = 38) waves after placement. We used growth curve models to examine longitudinal trajectories of adaptation in various measures of stress, global well-being, and psychosocial resources. Results: The findings suggested sharper decreases in stressors (e.g., role overload) and indicators of negative mental health in the shorter term panels. However, more significant intraindividual variation existed in caregivers' adaptation to placement in the longer term panels (four and five waves of postplacement). Implications: There is relative stability in caregiver long-term adaptation to institutionalization. However, the variability in adaptation emphasizes the need to target postplacement clinical interventions to families most at risk for negative outcomes during the transition to institutional care. (Contains 3 footnotes, 2 tables, and 3 figures.)