Assistive technologies in reducing caregiver burden among informal caregivers of older adults: a systematic review

Aim: The world population is rapidly ageing. As population age, the incidence of functional limitations increases, demanding higher levels of care from caregivers. Assistive technologies improve individuals’ functioning, independence, well-being and quality of life. By increasing independence of older adults, assistive technologies decrease workloads required from informal caregivers. This review investigates, evaluates, and synthesises existing findings to examine whether and how assistive technologies reduce caregiver burden. Methods: Databases searched included MEDLINE, EMBASE, Scopus, and Cochrane Library. Three groups of keywords were combined: those relating to assistive technology, caregiver burden, and older adults. Results: Two theories emerged from the analysis of study results. Caregivers reported that assistive technologies decrease caregiver burden. However, caregivers had concerns that assistive technologies could add to caregiver burden, highlighting the limitations of assistive technology. Conclusions: As suggested by a majority of the studies in this review, assistive technologies contribute to reducing caregiver burden among caregivers of older adults. Assistive technologies assisted caregivers by reducing time, levels of assistance and energy put towards caregiving, anxiety and fear, task difficulty, safety risk particularly for activities requiring physical assistance and increasing the independence of the users. Further research is required to better understand limitations of assistive technologies.

• Implications for Rehabilitation

• Support for informal caregivers of older adults need more attention and recognition.

• Assistive technologies can reduce caregiver burden among informal caregivers of older adults.

• Further research is required to better understand the effectiveness of assistive technologies in reducing caregiver burden as well as limitations and barriers associated with using assistive technologies.

     

截瘫患者家庭照顾者负担及其影响因素分析

目的探讨截瘫患者主要照顾者的负担及其影响因素：方法采用照顾者负担问卷、特质应对问卷、家庭关怀指数、生活质量自评及Karnofsky活动指数对80例居家治疗截瘫患者的主要照顾者进行调查.结果截瘫患者家庭照顾者身体、心理、社会方面的负担较大,其中社交负担最重.与常模相比,照顾者更多采用消极应对方式,这种消极应对方式与照顾者负担呈正相关。照顾者负担与患者的活动指数、自理情况、主观生活质量、瘫痪时间、家庭关怀度指数,以及家庭经济负担相关：结论应重视截瘫患者家庭照顾者的负担,指导其采用积极的应对方式,加强家庭支持系统,积极鼓励患者自理,以减轻照顾者负担.     

Morphine is not the only analgesic in palliative care: literature review

BACKGROUND: No comprehensive review has been published to date, which provides information for nurses on pharmaceutical alternatives to morphine in palliative care. As nurses are often the health professional most involved with terminally ill patients, there is a clear need for a review of current practices which is accessible to nurses. AIM: The aim of this review is to examine the pharmaceutical alternatives to morphine use in palliative care that are currently available. METHODS: Searches were made of the CINAHL and MEDLINE databases for articles published between 1990 and 2000, using the keywords 'pain management', 'cancer pain' and 'morphine'. FINDINGS: Most evidence on the use of pharmaceutical alternatives to morphine is anecdotal, demonstrating a need for more research to be conducted in this field. Evidence presented in this review shows encouraging results following the administration of methadone, fentanyl or ketamine to patients with difficult pain problems. CONCLUSION: Nurses need to be aware of treatment options that may benefit patients with difficult pain problems. Although positive experiences have been documented when using alternatives to morphine, more research must be conducted to allow practitioners to add more pharmaceutical alternatives to their pain management armouries.     

Analysis of missing data in palliative care studies

This report discusses the general problem of the analysis of data that could include missing values. In the palliative care setting, the data may not be missing at random, but instead be related to the outcome of interest, and therefore the use of standard statistical procedures may be problematic. This study summarizes differing results that were found when using three simple methods for estimating missing data in an example data set testing for differences in the use of morphine or methadone for relief of pain. Differences in the conclusions are discussed and recommendations are made to improve the reporting of studies with missing data.     

Exploring community nurses' perceptions of life review in palliative care

Aims and objectives. This exploratory study aimed to identify community nurses’ understanding of life review as a therapeutic intervention for younger people requiring palliative care. The objectives set out to: (i) Describe the participants’ understanding of reminiscence and life review (ii) Detail their current ideas regarding a structured approach to using life review in the community setting. (iii) Outline their understanding of the possible advantages and limitations of life review in relation to palliative care. (iv) Identify future training requirements. Background. The literature review illustrated how the eighth developmental stage of Erikson's theory, ego‐integrity vs. despair, is a ‘crisis’ often faced by older people entering the final stage of life. Life review is considered a useful therapeutic intervention in the resolution of this crisis. Younger terminally ill people in the palliative stage of an illness may face the same final crises due to their reduced lifespan. Therefore, this study explored the benefits and limitations of life review as an intervention in palliative care. Method. The study used a purposive sample of community nurses responsible for delivering generic and specialist palliative care. A qualitative method of data collection in the form of three focus group interviews was used. Subsequent data were manually analysed, categorized and coded with associations between the themes identified. Results. The findings suggested that community nurses have limited knowledge pertaining to the use of life review and tend to confuse the intervention with reminiscence. Furthermore, they believed that life review could potentially cause harm to practitioners engaged in listening to another person's life story. However, the participants concur that with appropriate training they would find life review a useful intervention to use in palliative care. Conclusions. The results led to the identification of a number of key recommendations: Community nurses require specific education in the technicalities of life review and additional interpersonal skills training. The need for formalized support through clinical supervision is also recognized and discussed. Finally, suggestions are offered regarding the need to generate wider evidence and how, possibly, to integrate life review into existing palliative care services. Relevance to clinical practice. This study has demonstrated that community nurses are keen to extend the support offered to younger terminally ill people who are in the palliative stage of their illness. Despite having limited knowledge of life the main components and underpinning theory pertaining to life review participants could appreciate the potential of life review as a therapeutic intervention in palliative care and were keen to learn more about its use and gain the necessary knowledge and skills.     

A concept analysis of palliative care in the United States

PURPOSE: The purpose of this analysis is to trace the evolution of the concept of palliative in the United States, explicate its meanings, and draw comparisons with other related concepts such as hospice care and terminal care. METHODS: Rodgers' evolutionary method was used as an organizing framework for the concept analysis. Data were collected from a review of CINAHL, MEDLINE, CANCERLIT, PsycINFO and Sociological Abstracts databases using 'palliative care' and 'United States' as keywords. Articles written in the English language, with an abstract, published between 1965 and 2003 were considered. Data were synthesized to identify attributes, antecedents and consequences of palliative care. FINDINGS: There has been a significant evolution in understanding of the palliative care concept in the United States over the last few decades, which has resulted in the emergence of new models of palliative care. Four attributes of the current palliative care concept were identified: (1) total, active and individualized patient care, (2) support for the family, (3) interdisciplinary teamwork and (4) effective communication. Results reinforce that cure and palliation are not mutually exclusive categories. CONCLUSIONS: The scope of palliative care has evolved to include a wide range of patient populations who may not be appropriately termed 'dying' but for whom alleviation of suffering and improvement of quality of life may be very relevant goals. The ultimate success of the new models of palliative care will eventually rest upon the commitment of health professionals to recognize and integrate the changing concept of palliative care into everyday practice.     

Methodological issues in male caregiver research: an integrative review of the literature

PURPOSE OF THE PAPER: The purpose of this integrative review of the literature is to identify sampling and analysis issues related to gender in caregiver research in the nursing and health literature. BACKGROUND: Men provide approximately 28% of the care in the home to functionally impaired elders in the United States of America (USA), and because of demographic predictions are expected to provide more in the future. Social science research related to male caregivers has been criticized as having many limitations. A critical review of the nursing and health literature would be helpful to nursing researchers and clinicians by identifying limitations in caregiving research related to gender and providing direction for future research. METHODS: A literature search using the CINAHL database and the terms 'family caregiver', 'dementia', and 'male' was conducted. Thirty-six articles were retrieved, reviewed, and abstracted. FINDINGS: Thirteen articles were qualitative studies, 22 were quantitative, and one had both qualitative and quantitative components. Many of the studies used small samples, and no analysis was included by gender. Most of the samples were convenience samples, with many being self-selected. There was also a lack of analysis of data by family relationship. No qualitative studies and only nine of the quantitative studies included analysis of the data by gender. Studies that reported by gender were all cross-sectional. CONCLUSIONS: There is a need for caregiver research that has larger samples of males, and includes analysis by gender and family relationship. There is also a need for more intervention studies that are well controlled, and evaluate the effect of the intervention on both male and female caregivers.