Background: With the aging of the global population, the prevalence and incidence of Alzheimer’s disease or related dementia are increasing. Most mild or moderate dementia clients are taken care of at home by informal caregivers, which leave a heavy burden to the caregivers. Researchers have found out that with good intervention services and programmes for the caregivers, their burden, emotional distress and even the care recipients’ symptoms and institutionalization rates would be improved. Objectives: This project is to review these researches to evaluate whether the interventions are effective and/ or cost-effective and how the decision-makers could use the results for evidence-based policy. Methods: A literature search was performed on randomized controlled trials in education, information/ support intervention programmes published from October 2005 to July 2012. Electronic databases (EBSCO, PubMed and CNKI) were searched until July 2012. The Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting randomized controlled trials was used as the guideline to evaluate the quality of identified papers. Results: 16 papers (15 studies) were included in this review and classified into three groups, as home-based, individual-based and group-based interventions. This review found that the intervention programmes had various outcomes and showed some evidence of effectiveness. Most of the papers had good quality. The home-based programmes showed cost-effectiveness in the identified studies. Conclusion: There was some evidence that the home- and group-based interventions were effective and the home-based interventions could be cost-effective. Further studies are recommended and a meta-analysis on the studies and more researches on economic analysis are needed. A community-based long-term dementia management should be built up for better outcomes. / published_or_final_version / Public Health / Master / Master of Public Health

Context: Dementia impairs daily functional ability and independence through negatively affecting cognitive function. As the prevalence of dementia increases, the burden on healthcare facilities and families grows, pointing to the need for providing further options available for the management of dementia in the community context. Of these options, physical exercise interventions are easily modifiable and relatively simple to implement. The primary objective of this review is to investigate the effectiveness of exercise for improving cognitive function in elderly people with dementia living in the community. Methods: A systematic review of 2 databases (PubMed and EMBASE) was carried out for all studies investigating the effects on cognition of a physical exercise intervention among home-dwelling elderly patients with dementia. Data was extracted on baseline characteristics of study participants, type of exercise intervention, length of follow up, and changes in cognitive outcome measures. Results: Seven studies were included. Three provided statistically significant results that showed an association between exercise and cognition in community-dwelling dementia patients.!The remaining four studies could not establish an association. Conclusions: The effectiveness of exercise for improving cognition in community-dwelling people with dementia is unclear based on the conclusions of this review. Small sample size and methodological quality limited the results. Further well-designed studies are needed that investigate appropriate community-based exercise interventions for people with dementia. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

This thesis explores the communication of a group of older people with dementia living in a residential care home and specifically, seeks to understand how living with dementia in a care home influences communication. The study draws broadly on a symbolic interactionist perspective and uses an ethnographic, inclusive, video methodology. In so doing, the study grounds the research in the experiences of the older residents with dementia and explores communication as it is interwoven with social life. The empirical data, on which this thesis is based, were gathered over the course of six months in one residential care home in Central Scotland. Analysis of these data, in conjunction with the theoretical literature informing the study, led to the development of a framework and a set of concepts to understand the communication of the older people with dementia living in residential care. This framework was used to examine the ways in which the older residents' experiences of institutionalisation, ageing, and dementia, generally, and of life in the care setting, specifically, influenced their communication. The findings revealed that the older residents made diverse meanings of their experiences in the home, and mat many of the meanings that they made were threatening to their self-identity, self-determinacy and social relationships. The residents engaged in a range of strategies to respond to the impact of these meanings and to negotiate their life in the care home. The research presented in this thesis has many implications for understanding the experiences of older people with dementia in residential care. In particular, the research highlights the need for a new social understanding of dementia, that examines the experience of dementia in relation to broad structural and cultural processes and that seeks to promote the social inclusion and citizenship of older people with dementia.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Objective: To synthesis evidence from systematic reviews at international level to explore effective community and home based care interventions for family caregivers (FCGs), which may affect quality of life of persons with dementia (PWDs) and their FCGs in China. Methods: A systematic review of reviews was conducted. Studies were identified through Scopus, PubMed and EBSCO databases. Non-pharmacological interventions targeted on FCGs with outcome domains related to psychological health or quality of life of PWDs and/or their FCGs were within this review scope. Quality of systematic reviews was evaluated by AMSTAR. Quality of primary studies included in the systematic reviews was assessed by their internal and external validity. Results: Three systematic reviews of moderate to high quality with 74 publications were included in this systematic review. Among the primary studies, about 60% were conducted by randomized controlled design, and about 85% were carried out in high-income countries. Results at review level suggested that communication skills training, internet-based care management, coping strategy, individual behavioral management techniques were effective interventions for FCGs of PWDs. In contrast, most of the primary studies reported that community or home based interventions positively affected FCGs and/or PWDs. Those interventions included communication skills training, internet-based care management, supportive therapy, educational intervention, coping strategy, behavioral management techniques; yet the effects yielded statistically insignificant in most of the trials. In particular, significant effects of community care interventions were found in 8 of 69 trials on FCGs’ psychological health, 3 of 4 trials on FCGs’ competence, 0 of 2 trials on FCGs’ quality of life, and 3 of 7 trials on PWDs’ quality of life. Combination of those community care intervention components was observed in most of the trials with significant effects. Conclusion: Communication skills training, internet-based care management, supportive therapy, educational intervention, coping strategy, behavioral management techniques had positive effects on FCGs of PWDs living in the community. The combination among those intervention components and designing intervention model in FCG needs-oriented manner underpinned a potential significant effect. Given distinguished social economic contexts in urban and rural areas, implementation of community care interventions specific to FCGs in China should be handled with cautions and strengthened by policy supports to empower aging at home. / published_or_final_version / Public Health / Master / Master of Public Health

Caring for a family member or loved one with dementia places a heavy burden on those providing the care. Caregivers often develop chronic depression because of having to deal with this burden. A great deal of literature has been published discussing coping effectiveness, effects of social support, and other internal and external means of support for the caregiver. However, little has been written about the changes, if any, in depression that the caregiver experiences after the termination of care, either through institutionalization or death of the person with dementia. This study examined whether there is a change in depression of spousal caregivers after institutionalization of the dementia care recipient as well as any changes in depression that may have occurred as a result of the death of the dementia care recipient. Two theoretical models, the wear and tear model and the adaptation model were discussed in terms of caregiver depression after institutionalization of the dementia care recipient. Two other theoretical models, the relief model and the stress model, were discussed in terms of caregiver depression after the death of the dementia care recipient. Datasets from the National Institute on Aging sponsored Health and Retirement Study were analyzed. Results indicate that both male and female spousal caregivers report an increase in depression after the institutionalization or death of the dementia care recipient, but that as time passes, males report a decrease in depression while females continue to report an increase in depression.

Agitated behaviours in dementia elderly predispose to negative outcomes. Music intervention is an evidence-based intervention that could help to ease the situation. The integrative and systematic review studies provide evidence that music intervention is effective in reducing agitated behaviours in dementia elderly. The assessment of the implementation potential, the feasibility and transferability demonstrate the music intervention can be implemented in local setting. An evidence-based guideline based on the reviewed papers is developed to use in local HK hospitals or nursing homes. With the help of an effective communication plan to the stakeholders, it is believed that the intervention can be smoothly implemented. Further evaluation helps to review the potentials for sustaining the intervention in the long run. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Caregiving for two parents affected by chronic dementia was the original impetus for this study. My negative experiences led to a quest for insight and solutions through volunteer, professional and academic pursuits. It culminated in this exploration of caregivers' experiences and their decision-making to expose the educational support they need. Caregivers tend to be family members, and overwhelmingly women. Studies from various disciplines confirm that caregivers need educational support to make decisions. Yet, little is known about what type of educational support they need and how it is to be provided. Caregivers' voices are seldom included in research and they are frequently blamed for the problems they confront. This qualitative study honours caregivers' voices. Through in-depth semi-structured interviews, the perspectives of five women form my primary source of data. Personal documentation, archival materials, and interviews with experts in the field supplement these data. To analyze the data two complementary analytic approaches are used: categorization and contextualization. A categorization approach organizes the data into conceptual themes. These themes include activities of multitasking, being locked into a state of heightened alert, interpreting the disease, and managing care. These activities reveal physical and psychological suffering. Contextualization approaches situate the dilemmas the women face in particular contexts. These dilemmas highlight their lack of authority. The analyses indicate that the women engage in a wide range of decision-making and that they need both similar and specific types of educational support. These types of support include (1) lessening their burdens and their frustrations of decision-making; (2) facilitating ethical decision-making; (3) providing information about medical treatments; and (4) assisting with the access to and with the assessment of suitable resources. Overall, caregiving is a ve

This study set out to evaluate a small scale model of care for people with dementia that aimed to support residents within a daily household routine (termed household care). Stemming from a pluralistic evaluation, this thesis examines issues identified as important to residents' experience, namely the ability of the care houses to provide a home for life, the process and effectiveness of recreating a homely environment and the implications of group-living. Three case studies were investigated with multiple methods, including semi-structured interviews with staff, relatives and representatives of managing agencies, structured observation and assessment of dependency. Respondents believed care housing was superior to its alternatives and attributed perceived improvements in residents' well-being to the nature of staff support and the 'homely' setting. Agency representatives were preoccupied with their relationships with each other and how to sustain and expand this model of care. Staff focused on the nature and conditions of the work. Kin were keen that residents should settle and stay in the care houses. Residents' support needs at least matched entry criteria but over half had to move out to hospital because of physical illness and behavioural problems. This study suggests that it was very difficult for residents to accept the houses as 'home'. Residents' and their relatives' participation was, in practice, limited but one house was particularly successful in implementing household care; reasons are suggested for this. Residents' interactions with each other seemed to be increased by household care but their relationships were influenced by a number of factors, including the presence of dementia. The latter exacerbated the tensions of group-living. The challenge for care houses was to sustain care as dementia progressed and extend good quality care to those with more substantial behavioural and physical support needs.