ABSTRACT
OBJECTIVES: This article describes results of a quality improvement project review of 5 years of capacity evaluations for independent living conducted in one Home-Based Primary Care (HBPC) Program. METHODS: A retrospective chart review was conducted for all patients evaluated for independent living capacity through the Boston VA HBPC Program (N = 25) to identify differences in outcomes for those with and without capacity. Descriptive information included referral sources, capacity decisions, time remaining in the home, and trajectory of patients following evaluation. RESULTS: All patients evaluated had been diagnosed with a cognitive disorder, and on average, a relatively lower prevalence of mental illness compared with the national HBPC population. Referrals were made primarily by the HBPC team. Patients with capacity were found to have remained in their home longer than those who lacked capacity. CONCLUSIONS: Referral for a higher level of care was typically only recommended when no further intervention could be implemented and active risk in the home could not be managed. CLINICAL IMPLICATIONS: In home capacity evaluations are complex and challenging, yet results help family and HBPC team support patients' preferences for staying in their own home as long as possible.
Subject(s)
Geriatric Assessment , Home Care Services/organization & administration , Independent Living/psychology , Patient Acceptance of Health Care , Quality Improvement , Aged , Aged, 80 and over , Cognitive Dysfunction/complications , Cognitive Dysfunction/psychology , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Patient Preference , Primary Health Care/organization & administration , Retrospective Studies , Risk AssessmentABSTRACT
The purpose of the study was to identify factors that influenced family caregivers' decisions to participate in an intervention research study. In interviews conducted before and after the intervention, caregivers (n=21) described reasons for participation. A focused content analysis was used to examine responses. Themes that emerged included: (a) caregivers recognized a need for help; (b) expectations and motivations toward change; (c) recognition of self worth as caregivers; (d) timeliness of recruitment strategies; (e) support of research staff affected recruitment; and (f) caregivers recognized the benefits of participation. These findings support the importance of many different strategies for effective recruitment of caregivers in future studies.
Subject(s)
Attitude to Health , Caregivers/psychology , Family/psychology , Nursing Assessment/methods , Nursing Methodology Research , Patient Selection , Adult , Aged , Aged, 80 and over , Alzheimer Disease/nursing , Decision Making , Female , Health Services Needs and Demand , Home Nursing/psychology , Human Experimentation , Humans , Male , Middle Aged , Motivation , Nursing Methodology Research/organization & administration , Retrospective Studies , Self Concept , Southwestern United States , Surveys and Questionnaires , Time FactorsABSTRACT
The purpose of this study was to compare emotional and biological responses of men and women who are spousal caregivers of patients with Alzheimer's disease (AD). Quality-of-life measurements, bioinstrumentation data, and immunophenotype assessments were obtained from female and male spousal caregivers of patients with AD. Spousal caregivers (women, n = 45 with average age 69.7; men, n = 16 with average age 71.4 years) completed questionnaires that assessed psychosocial variables. Blood was drawn and lymphocyte subsets (including natural killer [NK] cell number) were determined using flow cytometry. The degree of relaxation was determined measuring muscle tension (EMG) in the frontalis and trapezius muscles, skin conductance, skin temperature, and heart rate. Male spousal caregivers, as compared to female spousal caregivers, had significantly lower levels of stress, depression, caregiver burden (subjective), anxiety, anger-hostility, and somatic symptoms and higher levels of mental health, sense of coherence, NK cell number, and social and physical functioning. There were no statistically significant differences between the 2 groups in social support, coping resources, or T, T suppressor, or activated T cells. Women had more T helper cells and fewer NK cells than men. Men had fewer manifestations of a physiological stress response, as indicated by bioinstrumentation parameters. Unique sex-specific issues need to be considered when strategies are implemented to assist the increasing number of caregivers as our society ages.
