Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: FG serves on the executive committee for the UK Health Alliance on ...Climate Change and is a Trustee of the Eden Project. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature, and protect health. Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades 1. Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality 5,6.
Quality of life in dementia: a study on proxy bias Arons, Alexander M M; Krabbe, Paul F M; Schölzel-Dorenbos, Carla J M ...
BMC medical research methodology,
09/2013, Letnik:
13, Številka:
1
Journal Article
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Measurement of health-related quality of life (HRQoL) in dementia is difficult. At some point people with dementia become unable to meaningfully assess their own HRQoL. At such a point in time ...researchers need to rely on other types of information such as observation or assessments from informal caregivers (proxies). However, caregiver assessments may be biased by several mechanisms. The current study explores whether caregivers project part of their own HRQoL in their assessments of patient HRQoL.
The participants in the current study were 175 pairs, consisting of community-dwelling persons with dementia and their caregivers. The EQ-5D, the EQ-VAS and the QoL-AD were administered to collect HRQoL measurements from patients and caregivers at baseline, 6 months and 12 months. Two linear mixed models were used to investigate factors that bias proxy ratings, one with the EQ-VAS as dependent variable, and one with the EQ-5D utility as dependent variable. The independent variables were caregiver age, caregiver sex and caregiver QoL-AD items.
The linear mixed model with EQ-VAS as dependent variable indicated that 3 caregiver characteristics, namely caregiver age, money (caregiver's financial situation) and valuation of life as a whole were significant predictors of the patient-by-proxy VAS scores. The linear mixed model with utility value as the dependent variable showed that caregiver age and valuation of the ability to do things for fun were significant predictors of the patient-by-proxy EQ-5D utility values.
The current study was a first step in identifying factors that bias patient-by-proxy HRQoL assessments. It was discovered that caregivers project part of their own HRQoL onto patients when assessing patient HRQoL. This implies that patient-by-proxy HRQoL values should be interpreted with caution and not be used as a direct substitute for patient self-assessment, even when patients are no longer able meaningfully assess themselves.
Older people suffering from frailty often receive fragmented chronic care from multiple professionals. According to the literature, there is an urgent need for coordination of care.
The objective of ...this study was to investigate the effectiveness of an online health community (OHC) intervention for older people with frailty aimed at facilitating multidisciplinary communication.
The design was a controlled before-after study with 12 months follow-up in 11 family practices in the eastern part of the Netherlands. Participants consisted of frail older people living in the community requiring multidisciplinary (long-term) care. The intervention used was the health and welfare portal (ZWIP): an OHC for frail elderly patients, their informal caregivers and professionals. ZWIP contains a secure messaging system supplemented by a shared electronic health record. Primary outcomes were scores on the Instrumental Activities of Daily Living scale (IADL), mental health, and social activity limitations.
There were 290 patients in the intervention group and 392 in the control group. Of these, 76/290 (26.2%) in the intervention group actively used ZWIP. After 12 months follow-up, we observed no significant improvement on primary patient outcomes. ADL improved in the intervention group with a standardized score of 0.21 (P=.27); IADL improved with 0.50 points, P=.64.
Only a small percentage of frail elderly people in the study intensively used ZWIP, our newly developed and innovative eHealth tool. The use of this OHC did not significantly improve patient outcomes. This was most likely due to the limited use of the OHC, and a relatively short follow-up time. Increasing actual use of eHealth intervention seems a precondition for large-scale evaluation, and earlier adoption before frailty develops may improve later use and effectiveness of ZWIP.
The UN General Assembly in September 2021 will bring
countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They
will meet again at the ...biodiversity summit in Kunming,
China, and the climate conference (COP26) in Glasgow,
UK. Ahead of these pivotal meetings, we—the editors of
health journals worldwide—call for urgent action to keep
average global temperature increases below 1.5 °C, halt
the destruction of nature, and protect health.
The UN General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the ...biodiversity summit in Kunming, China, and the climate conference (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we-the editors of health journals worldwide-call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature, and protect health.
Errorless learning (EL) is a principle used to teach new information or skills to people with cognitive impairment. In people with dementia, EL principles have mostly been studied in laboratory tasks ...that have little practical relevance for the participants concerned, yet show positive effects. This is the first paper to exclusively review the literature concerning the effects of EL on the performance of useful everyday tasks in people with dementia. The role of factors such as type of dementia, type of task, training intensity, EL elements, outcome measures, quality of experimental design, and follow-up are discussed. The results indicate that, compared with errorful learning (EF) or no treatment, EL is more effective in teaching adults with dementia a variety of meaningful daily tasks or skills, with gains being generally maintained at follow-up. The effectiveness of EL is highly relevant for clinical practice because it shows that individuals with dementia are still able to acquire meaningful skills and engage in worthwhile activities, which may potentially increase their autonomy and independence, and ultimately their quality of life, as well as reduce caregiver burden and professional dependency. Suggestions for future research are given, along with recommendations for effective EL-based training programs, with the aim of developing a clinical manual for professionals working in dementia care.
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