Examining the Needs of Family Caregivers of People Living with Dementia in the Community during the COVID-19 Pandemic.

The COVID-19 pandemic has had a disproportionate effect on older adults and their family caregivers (FCGs). For FCGs, the pandemic has impacted almost every dimension of their lives and caregiving routines, from their own risk of becoming ill to their access to resources that support caregiving. The purpose of this mixed-methods study was to examine the impact of COVID-19 on FCGs' ability to provide care for their family member with dementia. A total of 115 FCGs who identified as having their family member living with dementia residing in the community completed the survey. Ten family caregivers participated in the follow-up focus groups. Recommendations to address the needs of FCGs now and in the future include: (1) making resources for care provision consistently available and tailored, (2) providing support for navigating the health care system, and (3) supplying concise information on how to provide care during public health emergencies.

Prise en charge médicamenteuse de l'opposition aux soins chez la personne âgée avec troubles cognitifs

Introduction L'opposition aux soins fait partie des troubles psycho-comportementaux (SCPD) observé chez la personne âgée présentant des troubles neurocognitifs. Objectifs Comment agir face à cette situation difficile ? Quelle attitude thérapeutique adopter pour préserver la vie du patient tout en respectant sa dignité ? Méthodes On rapporte un cas clinique pour illustrer les difficultés de la prise en charge. Résultats Il s'agit de MR M. A âgé de 87 ans (HTA ;DNID) qui présente des troubles cognitifs (TNC) depuis 1 année et demi. Suite au Covid-19, il subit une amputation de sa jambe gauche et perd sa femme, quelques jours après, il refuse de s'alimenter, de parler, de boire et de prendre ses médicaments. Il meurt quelques semaines plus tard malgré les soins à domicile entrepris contre sa volonté. S'agit-il d'un équivalent suicidaire ? Discussion Cette opposition témoigne d'une grande souffrance morale, un désir de se laisser mourir. À ce jour, il n'existe aucune approche standardisée permettant au clinicien de savoir si une opposition reflète une décision éclairée ou une attitude qui témoigne plus d'une réaction comportementale. La prise en charge nécessite une analyse sémiologique descriptive afin de mieux comprendre la symptomatologie pour pouvoir agir rapidement avec efficacité. Conclusion La prise en charge d'une opposition aux soins est tout d'abord non médicamenteuse puis médicamenteuse avec un soutien de l'aidant et du soignant.

A Scoping Review of Care Trajectories across Multiple Settings for Persons with Dementia.

Multiple transitions across care settings can be disruptive for older adults with dementia and their care partners, and can lead to fragmented care with adverse outcomes. This scoping review was conducted to identify and classify care trajectories across multiple settings for people with dementia, and to understand the prevalence of multiple transitions and associated factors at the individual and organizational levels. Searches of three databases, limited to peer-reviewed studies published between 2007 and 2017, provided 33 articles for inclusion. We identified 26 distinct care trajectories. Common trajectories involved hospital readmission or discharge from hospital to long-term care. Factors associated with transitions were identified mainly at the level of demographic and medical characteristics. Findings suggest a need for investing in stronger community-based systems of care that may reduce transitions. Further research is recommended to address knowledge gaps about complex and longitudinal care trajectories and trajectories experienced by sub-populations of people living with dementia.

Physicians' Characteristics and Attitudes Towards Medically Assisted Dying for Non-Competent Patients with Dementia.

The federal and Quebec governments are both considering extending medical aid/assistance in dying (MAID) to non-competent patients who would have requested MAID prior to losing capacity. In 2016-2017, we surveyed 136 Quebec physicians (response rate: 25.5%) on their attitudes towards extending MAID to such patients. Complementing our published findings, we herein identify demographic and practice characteristics that distinguish physicians who reported being open to extending MAID to non-competent patients with dementia, or willing to administer MAID themselves should it be legal, from those who were not. We found that physicians who were older, had stronger religious beliefs, were trained in palliative care, practiced in a teaching hospital, and had not received assisted dying requests in the year preceding the survey held less favourable attitudes towards MAID for non-competent patients with dementia. These findings will inform current deliberations as to whether assistance in dying should be extended to non-competent patients in some circumstances.

In Their Own Words: How COVID-19 Has Impacted the Well-Being of Persons Living with Dementia in the Community.

COVID-19 has had a devasting impact on older adults in Canada, including persons living with dementia. This intrinsic case study sought to understand the perceptions of persons living with dementia regarding how COVID-19 has impacted their well-being. Ten persons living with dementia participated in in-depth qualitative interviews about their experience with COVID-19. Using thematic analysis, four themes were identified: (1) expressing current and future concerns; (2) social connections and isolation; (3) adapting to change and resilience through engagement and hope; and (4) we're not all the same: reflecting individual experiences of the pandemic. Results highlight that while COVID-19 contributed to isolation, concerns, and frustrations, persons with dementia also demonstrated adaptation and resilience. This study reinforced that persons with dementia and their responses to challenges are unique. Therefore, interventions to support persons with dementia must also be individualized to each person's abilities and circumstances.