Potential for identification of memory problems in the cancer clinic to enable improved treatment experience and outcomes: Mixed methods case study research.

PURPOSE: To inform improvement in cancer treatment experience and outcomes for people with dementia or milder cognitive impairment. People with dementia, compared to those without, experience more side effects from cancer treatment and have poorer outcomes including poorer survival. METHODS: The research was a mixed methods exploratory case study. Each case was a cancer treatment in a person with memory loss, a common symptom of dementia. Observations were conducted in 30 clinic sessions at one cancer centre between September 2014 and February 2015. Thirty-three encounters between people with a memory problem and a staff member were observed and ten consultations recorded. Interviews were conducted with five staff members and six people receiving cancer treatment, five accompanied by their carer. Analysis, informed by hermeneutic phenomenology, enabled the treatment pathway to be mapped and modelled to reveal sites for intervention. FINDINGS: Five potential sites of intervention were identified in the treatment pathway. Five actions at the sites of intervention that may improve patient experience and outcomes include, raising awareness of common problems for people with cognitive impairment receiving cancer treatment, encouraging disclosure of memory problems, staff training to identify memory problems and to know what to do, offering tools and techniques to aid self-management of memory problems, and addressing carer support needs. CONCLUSION: Embedding biomedical treatment of cancer within a dementia-friendly psychosocial system may enable safe cancer treatment for a greater number of people with dementia or milder cognitive impairment.

A review and commentary on the factors that influence expressions of sexuality by older people in care homes.

AIM: The aim of this paper is to review the literature on factors that influence the expression of sexuality by older people in care homes. BACKGROUND: Sexuality is an intrinsic part of what we are, however there is evidence to suggest that the sexual needs of older people are often overlooked, particularly in long-term care settings. Whilst there is information about sexuality and its expression in later life, questions remain as to how this influences and is influenced by the behaviours and experiences of residents and staff in care homes. DESIGN: A systematic search of online databases. METHOD: Databases using keyword and bibliographical searches in a specified timeframe were undertaken. Research studies ranging from 1996-2009 were selected for inclusion on the basis that they addressed issues relating to expressions of sexuality by older people in care homes. Forty articles were included in the review. FINDINGS: The review revealed a dearth of rigorous research on sexuality amongst older people in general and care home residents in particular. Issues identified in the literature were categorised into four broad thematic areas: sexuality and ageing, expression of sexuality in care homes, attitudes of staff and sexuality in dementia. CONCLUSION: There is a dearth of rigorous research on the factors influencing sexual expression by care home residents. Attitudes of staff in care homes influence their perceptions about the extent to which the expression of sexuality by residents is considered to be problematic. This, in turn influences the emotional and behavioural responses of staff to the resident. RELEVANCE TO CLINICAL PRACTICE: There is need for nurses and other care staff to gain a better understanding of and insight into late life sexuality. This involves change at an educational level but also at an organisational and cultural level in long-term care settings.