Most persons with a dementia are cared for in the home by family members who experience a broad and considerable amount of stress and whose caregiving careers may include planning for or initiating moves to memory care units (MCUs). This study examines the decision-making processes of primary informal caregivers regarding their care recipients' moves to MCUs. Grounded theory methods were used to collect and analyze data in two long-term care (LTC) facilities varying in characteristics including capacity, state licensure, fees, and resident profiles. Specific aims are two-fold: 1) advance an understanding of how primary informal caregivers of persons with a dementia made decisions for formal memory care, and 2) identify the important factors related to the decision-making process.

Background: Quality of care and patient safety have been demonstrated to be at increased risk during care transitions; making older adults with complex medical issues especially vulnerable due to the multifaceted care they require (Coleman, 2003; Cook et al., 2000; Forster et al., 2003; Murtaugh & Litke, 2002; Picker Institute, 1999; van Walraven et al., 2004). While a strong focus on patient issues during care transitions exists in current literature, there is a dearth of knowledge surrounding the role of informal caregivers in this process. As the senior population continues to grow in Canada, it is inevitable that the health system will be increasingly reliant upon informal caregivers to meet the demanding and complex care needs of older adults. This research explored informal caregiver experiences following an older patient’s medical crisis in order to foster a deeper understanding of caregiver needs during transitional care. This work will support efforts to develop viable interventions within formal care settings to better support and prepare individuals for informal care responsibilities (Canadian Caregiver Coalition, 2008; National Centre for Social and Economic Modelling, 2004). Methods: A qualitative, post-positivist grounded theory study was employed to acquire an understanding of the role and needs of informal caregivers during transitional care. Semi-structured interviews were conducted with six community and resource case managers, and informal caregivers of eight hip fracture and two stroke caregivers. Two additional interviews were conducted with hip replacement caregivers. Questions explored individual experiences interacting with and/or providing informal care, and honed in on observed and experienced challenges, support received, and recommendations for future efforts to support care. NVivo8 software facilitated qualitative data analysis through hierarchical coding (Glaser & Strauss, 1967). Results: Six properties of caregiver needs arose from the data, each consisting of several important ideas fostering its understanding. The core concept threading across all properties was building capacity to care. Combined, thematic interpretations were integrated into a comprehensive theory of caregiver needs to support a successful care transition from hospital to home, consisting of three layers: 1) Timeline of caregiver needs; 2) Instrumental needs; and 3) Emotional needs. A member-checking process of the theory consisting of both a focus group and individual interviews indicated high face and content validity, and highlighted priority areas for future interventions. Discussion: The developed substantive theory is a valuable tool for which to understand the instrumental and emotional needs of hip fracture and stroke caregivers along a timeline of transitional care between hospital and home. Focus group and individual feedback indicate strong endorsement for theory adoption as a guiding framework for an intervention strategy to support informal caregivers within formal care settings and throughout the transition home. Results suggest the potential to broaden the conceptualization of the substantive theory to a formal explanation of transitional care needs for other medical crises across numerous types of transitions between formal hospital settings and the community.

Relationer och sexualitet utgör grundläggande behov för alla människor men detta är något som ofta förbises av omgivningen när det gäller funktionsnedsatta personer. Studiens syfte var att undersöka hur Örebro kommuns ROS- policy för bemötande av brukares känslor, relationer och sexualitet tillämpas i dagliga arbetet på boenden med särskild service inom förvaltningen för funktionshindrade. Studien har haft följande frågeställningar: hur följer medarbetarna ROS- policyn, på vilket sätt kan medarbetarnas förhållningssätt påverka brukarnas möjligheter till relationer och privatliv. För att få svar på forskningsfrågorna användes kvalitativa intervjuer, för att generera uttömmande och detaljerade svar. Intervjuer genomfördes med elva enskilda medarbetare, vilka valts ut genom målinriktat urval via en pedagogisk verksamhetsutvecklare. Av resultatet tolkades att Örebro kommun behöver informera, utbilda samt stötta sina medarbetare ytterligare för att ROS – policyn skall få ökad inverkan i de olika verksamheterna för att i förlängningen öka möjligheterna för brukare att få leva som alla andra. / Relationships and sexuality are among the basic needs of all human beings but this is something that is often overlooked by the social environment concerning for disabled people. The aim of the study was to examine how Örebro (Relations and sexuality) ROS-policy for treatment of the disabled people’s emotions, relationships and sexuality, applied in daily work at accommodation with special services within the administration for the disabled. The research questions in the essay were; how employees follow the ROS-policy, how can employees 'attitudes affect the disabled people’s opportunities for relationships and personal life. In order to obtain answers to the research questions qualitative interview were used to prevail exhaustive and detailed answers. Interviews were conducted with 11 individual respondents, selected through a purposive sampling through an educational activity developer. The result was interpreted and showed that Örebro municipality needs to inform, educate and support their employees furthermore before the ROS-policy could be more influential in the residential caring homes in order to ultimately increase the opportunities for disabled to live like everyone else.

The purposes of this study were 1) to explore the associations between individual factors, disease factors, family factors, social factors and quality of life ( QoL ), 2) to predict QoL in patients with chronic mental illness ( CMI ), and 3) to understand the needs of caregivers. A cross-sectional and cluster sampling was employed. Structured questionnaires, including a living conditions questionnaire and a psychotic symptom assessment scale, Caregiver Burden Scale, 5-item Brief Symptom Rating Scale ( BSRS-5 ), and the Medical Outcomes Study Short Form-12 ( MOS SF-12 ) were used to collect data. Totally, 2023 patients were recruited, males 52.9%, females 47.1%, and a mean age of 44.99¡Ó12.09. Most of these cases were high school educated, unemployed, and had been hospitalized. 12.6% had a history of violence, 8.4% had a history of attempted suicide, 10% had substance abuse, and 5.4% had legal related issues. The most common diagnoses were schizophrenia¡]70.5%¡^and affective disorder¡]19.7%¡^. Single-factor analysis showed those who were unmarried, employed, younger, having less psychological problems, and low levels of psychological distress had better QOL. Besides, sex and education were not related to QOL in personal factors. Current psychotic symptoms and positive symptoms were negatively correlated with QOL. Schizophrenic patients and hospitalized patients reported higher QOL than bipolar patients and community patients in disease factors. Caregiver¡¦s attitude and caregiver¡¦s burden were negatively correlated with QOL in family factors. The unstable housing and community life dysfunction were negatively correlated with QOL in social factors. All significantly correlated variables were entered into hierarchical regression analysis followed the sequence of social factors, family factors, disease factors and individual factors. The results showed all four of these dimensions were significant predictors of MCS and PCS of QoL, explained variance 48.2¢H and 21.2¢H, respectively. Conclusions: Individual factors and disease factors are the most important factors in predicting QoL in CMI patients. Second, family factors are more important than social factors in MCS, and social factors are more important than family factors in PCS. The above evidence indicates a wide range of factors must be considered to improve the QoL in CMI patients.

Title: “Effects of Power Toothbrushing on Oral Inflammation, Caregiver Adherence, and Systemic Inflammation in a Sample of Nursing Home Residents” Objectives: The aims of this study were to investigate whether twice daily use of a rotating–oscillating power toothbrush (Oral-B Professional Care 1000 ™) in nursing home (NH) residents over a six-week period of time, as compared to usual care, would: (1) reduce oral inflammation; (2) increase caregiver adherence with oral care; and (3) reduce systemic inflammation. Methods: In this repeated measures single-blinded randomized controlled trial, 59 residents of one nursing home in Winnipeg, Canada, were randomized to receive either twice daily tooth brushing with a rotating-oscillating power toothbrush (PB) or usual care (UC) by caregivers. Consent was obtained from residents directly or from their proxies. Participants had some natural teeth; oral inflammation; non- aggressive behaviour; no communicable diseases; were non-smokers; and were non-comatose. Outcomes were recorded at baseline and 6 weeks, which included oral inflammation (MGI, Lobene), bleeding (PBI, Loesche), and Plaque (Turesky); systemic inflammation (hsC-reactive Protein, hsCRP) and caregiver adherence (self-reported twice daily toothbrushing). Caregivers completed a survey at study end regarding their oral care delivery preference. Group specific changes in oral outcomes and caregiver adherence were analyzed using a General Linear Model with a repeated measure. Changes in hsCRP were analyzed using non-parametric statistical tests, given challenges with the variance in these data. Survey results were analyzed using descriptive statistics. Results: Of the 59 original study participants, one withdrew and one died prior to initial data collection, and three individuals died before study completion. Oral health parameters improved significantly for the remaining 54 residents over time, (p< 0.0001) however equally for residents in each study group. HsCRP did not change significantly over time, overall or between residents in either study group. During all weeks combined, caregiver adherence was similar between study groups (40% for UC, 42% for PB). Caregiver adherence reduced significantly, from week 1 (48.6%) to week 6 (37.4%), with no significant differences between groups. Caregivers stated a preference for the power toothbrush (69%), and 78% reported it was easier to use than a regular brush. Conclusions: This study provides unique evidence about NH caregiver adherence to providing oral care for a sustained period of time. Despite this however, using as outcomes direct measures of inflammation, the oral health of NH residents improved significantly, albeit equally in both study groups. Given this disjoint in results, further studies are required to investigate improved methods for measuring caregiver adherence to the provision of daily oral care for NH residents.

The aim of this study was to describe how elderly’s sexuality can be expressed and to describe factors that affect older people's sexuality. The aim was also to describe the opportunities and barriers to health care providers to promote older people's sexuality and to describe the articles quality based on the methodological aspect of selection. A literature review with a descriptive approach was conducted on four qualitative and ten quantitative articles. The included articles were published between 2003 and 2013. Databases used for article search was PubMed, Cinahl and PsychInfo with the following keywords: Sexuality, Nurses, Aged, Geriatrics, Attitude Of Health Personnel, Residential Facilities, Quality Of Life, Older Adults. The Main results showed that elderly’s sexuality manifested itself in many different ways. The intimacy was to some extent more important than the actual intercourse. In general, poor health, diagnosed diseases, medical treatments and advanced aged had a negative impact on older people's sexuality. A clear policy with guidelines, education and guidance for staff were alternative ways to promote older people's sexuality. Caregiver’s uncertainty and negative attitude about the management and treatment of older people's sexuality was barriers to promoting older people's sexuality. Finally, inadequate or completely lack of guidance on the subject elderly and sexuality was barriers to promoting elderlies sexuality. Older people's sexuality is expressed highly individual and influenced by individual circumstances and situation. Few studies have been conducted on the subject elderly and sexuality, which is why further research in the area is necessary for further evidence. For proper care to be able to be performed more training and research is required in the subject elderly and sexuality.

Fourteen cancer caregivers participated in a six-week Vinyasa Yoga (VY) intervention and completed demographic items, psychological distress, measures of QOL, and open-ended questions. There was a significant difference and large effect (n2 =.47) in the total mood disturbance scores; t(13)= 3.43, p=0.005, 95% CI [8.6, 38.1]. There was no significant difference in the Physical Component Score; t(13)= 1.70, p=0.113, 95% CI [-.8, 6.8], n2 =0.18. There was a significant difference and large effect (n2 =.30) in the Mental Component Score; t(13)= -2.37, p=0.034, 95% CI [-12.9, -.6]. Additional analyses indicated that several subdomains of psychological distress and QOL were significant. Responses to the survey questions revealed participants perceived benefiting physically and mentally from the VY intervention, noting improvements in flexibility, core and upper-body strength, mindfulness, breathing, and energy. Although further and more rigorous exploration is required, this study provides support for the feasibility of VY with cancer caregivers.

Cognitive impairment in Parkinson’s disease (PD) can impact negatively on caregivers and is associated with carer distress and feelings of burden. To investigate this relationship we examined level of burden, coping strategies, depression, anxiety and potential positive aspects of caregiving in the caregivers of 104 PD patients. The PD patients were classified as either showing normal cognition (PD-N; n=57), with mild cognitive impairment (PD-MCI; n=31) or with dementia (PD-D; n=16). The key finding was that mean Zarit burden score increased between carers of PD-N (M=14.1, SD=12.0) through to PD-MCI (M=21.1, SD=9.86) and PD-D (M=27.8, SD=10.61); F (2,101) =9.96, p<0.001. Post hoc tests (Newman-Keuls) identified significantly higher Zarit burden scores in PD-D caregivers compared to both PD-N (p<.001) and PD-MCI patients (p<.05), but carers of PD-MCI patients also showed increased burden scores relative to those of PD-N patients (p<.05). The proportion of carers showing significant levels of burden (Zarit burden score ≥21) also increased as cognition declined (21% for PD-N; 58% for PD-MCI; and 81% for PD-D). Time spent providing care and problem-focused, emotion-focused and dysfunctional coping strategies also increased with worsening cognition. While caregiver use of problem-focused coping mediated the association between patient cognitive status and caregiver burden, we could not be confident about this relationship as the inverse model was also significant. Caregiver Zarit burden was independent of caregiver depression, anxiety and positive attributions of caregiving. The study highlights the impact of Parkinson’s disease on those providing care when the patients’ cognition is poor, including those with MCI. Caregiver well-being has important implications for nursing home placement and disease course.

Background: Quality of care and patient safety have been demonstrated to be at increased risk during care transitions; making older adults with complex medical issues especially vulnerable due to the multifaceted care they require (Coleman, 2003; Cook et al., 2000; Forster et al., 2003; Murtaugh & Litke, 2002; Picker Institute, 1999; van Walraven et al., 2004). While a strong focus on patient issues during care transitions exists in current literature, there is a dearth of knowledge surrounding the role of informal caregivers in this process. As the senior population continues to grow in Canada, it is inevitable that the health system will be increasingly reliant upon informal caregivers to meet the demanding and complex care needs of older adults. This research explored informal caregiver experiences following an older patient’s medical crisis in order to foster a deeper understanding of caregiver needs during transitional care. This work will support efforts to develop viable interventions within formal care settings to better support and prepare individuals for informal care responsibilities (Canadian Caregiver Coalition, 2008; National Centre for Social and Economic Modelling, 2004). Methods: A qualitative, post-positivist grounded theory study was employed to acquire an understanding of the role and needs of informal caregivers during transitional care. Semi-structured interviews were conducted with six community and resource case managers, and informal caregivers of eight hip fracture and two stroke caregivers. Two additional interviews were conducted with hip replacement caregivers. Questions explored individual experiences interacting with and/or providing informal care, and honed in on observed and experienced challenges, support received, and recommendations for future efforts to support care. NVivo8 software facilitated qualitative data analysis through hierarchical coding (Glaser & Strauss, 1967). Results: Six properties of caregiver needs arose from the data, each consisting of several important ideas fostering its understanding. The core concept threading across all properties was building capacity to care. Combined, thematic interpretations were integrated into a comprehensive theory of caregiver needs to support a successful care transition from hospital to home, consisting of three layers: 1) Timeline of caregiver needs; 2) Instrumental needs; and 3) Emotional needs. A member-checking process of the theory consisting of both a focus group and individual interviews indicated high face and content validity, and highlighted priority areas for future interventions. Discussion: The developed substantive theory is a valuable tool for which to understand the instrumental and emotional needs of hip fracture and stroke caregivers along a timeline of transitional care between hospital and home. Focus group and individual feedback indicate strong endorsement for theory adoption as a guiding framework for an intervention strategy to support informal caregivers within formal care settings and throughout the transition home. Results suggest the potential to broaden the conceptualization of the substantive theory to a formal explanation of transitional care needs for other medical crises across numerous types of transitions between formal hospital settings and the community.

It is well documented in the caregiving literature that caregivers do not utilize services that may aid in their ability to provide care and help maintain their own well-being. There have been several barriers identified that may deter caregivers from seeking services, especially in rural areas. However, there is less known about how caregivers work to overcome those barriers. The purpose of this study was to increase understanding about how rural caregivers overcome barriers to service utilization. The research was designed to be exploratory, rather than of a confirmatory nature. It is hoped that having rural caregivers identify ways to overcome the barriers themselves will ultimately be more meaningful as their suggestions might then be used to change how services market and deliver services to rural caregivers. This study was a qualitative investigation of what rural caregivers identify as barriers to seeking services and how to overcome those barriers. Eight rural caregivers were interviewed over the phone. Through the interview process, caregivers identified barriers and shared their personal experiences of how to overcome barriers or offered suggestion about how others may overcome barriers. Grounded theory (Strauss & Corbin, 1998; Corbin & Strauss, 2008) was used to analyze the qualitative data. The core phenomenon of this study, often referred to as a storyline, revolved around the concept of caregivers not seeing a need for services. Caregivers' cultural beliefs of staying independent and taking care of others because it is their familial responsibility were prevalent throughout the interviews. The findings from this study ultimately illustrate how caregivers do not seek services because they do not see a need to or chose not to need services. Although barriers to service utilization have previously been identified in the caregiving literature, the greatest barrier for each of the caregivers in this study was their inability to see a need for help or services. This emerged as a higher-order barrier. Although caregivers were able to offer suggestions to overcome some of the other barriers, none were able to offer suggestions on how to help caregivers perceive a need as they themselves had attitudes and/or beliefs that contributed to their not believing they needed services. Awareness of this higher-order barrier or core belief may translate into agencies and services changing the way they market to rural caregivers.