Caring for an individual with mild cognitive impairment: a qualitative perspective of health-related quality of life from caregivers

ABSTRACT

Objectives: Little is known regarding the effect that caring for an individual with Mild Cognitive Impairment (MCI) has on health-related quality of life (HRQOL). We sought to identify the most important aspects of HRQOL related to caring for an individual with MCI.

Methods: Six focus groups were conducted with caregivers of individuals with MCI (n = 32). Qualitative frequency analysis was used to analyze the data.

Results: Findings indicated that caregivers most frequently discussed social health, including changes in social roles and an increased need for social support (51.2% of the total discussion). This was followed by mental health concerns (37.9%) centering on anger/frustration, and a need for patience in the caregiving role, as well as caregiver-specific anxiety. Other topics included physical health (10.0%; including the impact that stress and burden have on medical heath), and caregivers’ cognitive health (0.9%; including memory problems in relation to caregiver strain, sleep disruption, and cognitive fatigue).

Conclusions: Findings illustrate the multiple domains of HRQOL that are affected in individuals providing care for someone with MCI. Moreover, the findings highlight the need for extending support services to MCI caregivers, a group that is typically not offered support services due to the ‘less severe’ nature of an MCI diagnosis.     

Supporting older people following out of hours discharge from the Emergency Department: An integrative review of the literature

Background

For many older people the emergency department (ED) is an important but sometimes difficult step in their healthcare journey. They often attend the ED with co and multi morbidities. Discharge home at evenings and weekends when post-discharge support services are limited can result in a delay or failure to follow through on their discharge plan leading to adverse health outcomes and in some cases, readmission to ED.

Objective

The aim of this integrative review was to identify and appraise the support available to older people following discharge from the ED out of hours (OOH).

Methods

For this review, out of hours referred to those times after 17.30 until 08.00 a.m. on Mondays to Fridays, all hours on weekends and public holidays. Whittemore and Knafl's (Journal of Advanced Nursing, 2005;52:546), framework was used to guide all stages of the review process. Articles were retrieved following a rigorous search of published works using various databases, the grey literature and hand search of the reference lists of the studies included.

Results

In total 31 articles were included in the review. These comprised systematic reviews, randomised control studies, cohort studies and surveys. Main themes identified included processes that enable support, support provision by health and social care professionals and telephone follow-up. Results identified a significant dearth of out of hours discharge research and a strong recommendation for more concise and thorough research in this important area of care transition.

Conclusion

Older person discharge home from the ED presents an associated risk as previous research has identified frequent readmission and periods of ill health and dependency. Out of hours discharge can be even more problematic when it may be difficult to arrange support services and ensure continuity of care. Further work in this area is required, taking cognisance of the findings and recommendations identified in this review.     

Korean beliefs about everyday memory and aging for self and others

Studies in the West have demonstrated that more everyday memory problems are expected for typical older adults than for typical young adults. In order to examine memory beliefs about aging in Asia, we conducted a study in Korea which parallels that of Ryan and Kwong See (1993). We used the three self-efficacy scales of the Metamemory in Adulthood instrument (Dixon & Hultsch, 1983) to determine whether age changes are anticipated for oneself as well as for typical adults. Young adults (N = 468; mean age = 21.0 years) rated the memory of either typical adults (aged 25, 45, or 65 years) or themselves at one of these ages. As in Ryan and Kwong See (1993), anticipation of decline was obtained on two of the three self-efficacy scales (i.e., capacity and change). In addition, beliefs about everyday memory decline (i.e., capacity and locus) were weaker for the self than for typical others. Hence, support was obtained for negative stereotypes about memory and aging in Korea as well as a self-protection bias indicating stronger anticipation of age-related decline among others.     

Risk factors for post-ERCP pancreatitis: a prospective, multicenter study

BACKGROUND: Post-ERCP pancreatitis is poorly understood. The goal of this study was to comprehensively evaluate potential procedure- and patient-related risk factors for post-ERCP pancreatitis over a wide spectrum of centers. METHODS: Consecutive ERCP procedures were prospectively studied at 11 centers (6 private, 5 university). Complications were assessed at 30 days by using established consensus criteria. RESULTS: Pancreatitis occurred after 131 (6.7%) of 1963 consecutive ERCP procedures (mild 70, moderate 55, severe 6). By univariate analysis, 23 of 32 investigated variables were significant. Multivariate risk factors with adjusted odds ratios (OR) were prior ERCP-induced pancreatitis (OR 5.4), suspected sphincter of Oddi dysfunction (OR 2.6), female gender (OR 2.5), normal serum bilirubin (OR 1.9), absence of chronic pancreatitis (OR 1.9), biliary sphincter balloon dilation (OR 4.5), difficult cannulation (OR 3.4), pancreatic sphincterotomy (OR 3.1), and 1 or more injections of contrast into the pancreatic duct (OR 2.7). Small bile duct diameter, sphincter of Oddi manometry, biliary sphincterotomy, and lower ERCP case volume were not multivariate risk factors for pancreatitis, although endoscopists performing on average more than 2 ERCPs per week had significantly greater success at bile duct cannulation (96.5% versus 91.5%, p = 0.0001). Combinations of patient characteristics including female gender, normal serum bilirubin, recurrent abdominal pain, and previous post-ERCP pancreatitis placed patients at increasingly higher risk of pancreatitis, regardless of whether ERCP was diagnostic, manometric, or therapeutic. CONCLUSIONS: Patient-related factors are as important as procedure-related factors in determining risk for post-ERCP pancreatitis. These data emphasize the importance of careful patient selection as well as choice of technique in the avoidance of post-ERCP pancreatitis.     

The effects of beta‐alanine supplementation on physical working capacity at heart rate threshold

Beta‐alanine (BA) supplementation has been shown to delay neuromuscular fatigue as a result of increased muscle carnosine concentrations. Carnosine has also been found in brain and cardiac tissue. The physical working capacity test at heart rate threshold (PWC_HRT) is a global estimate of the onset of fatigue during exercise, influenced by central and peripheral factors. The purpose of this study was to determine the effects of 28 days of BA supplementation on the PWC_HRT. Thirty subjects (mean ± SD; age: 21·0 ± 2·1 years; body mass: 72·7 ± 14·5 kg; height: 170·1 ± 7·9 cm) were randomly assigned to BA (n = 15) or placebo (PL, n = 15) groups. Testing included eight to nine total visits: an enrolment day, physical screening, peak oxygen consumption (V^·O_2peak) and two PWC_HRT assessments over 4 days. Significant differences existed between BA and PL for PWC_HRT (P = 0·001; mean?: BA? = +24·2 watts, PL? = +11·2 watts), but not for V^·O_2peak (P = 0·222), time to exhaustion (TTE; P = 0·562) or ventilatory threshold (VT; P = 0·134). Results suggest that BA may increase heart rate training threshold. These results, in combination with one previous study reporting a potential effect of BA on HR, suggest that future studies should evaluate both central and peripheral aspects of fatigue with BA intake.     

Aluminum activates an anion channel in the apical cells of wheat roots

We describe an anion channel in the plasmalemma of protoplasts isolated from wheat (Triticum aestivum L.) roots that is activated by aluminum (Al3+). In the whole-cell configuration, addition of 20-50 microM AlCl3 to the external solution depolarized the membrane and activated an inward current that could remain active for more than 60 min. The activation by Al3+ was rapid in 20% of protoplasts examined, whereas in another 30% a delay of more than 10 min occurred after Al3+ was added. Once the current was activated, changing the external Cl- concentration shifted the membrane reversal potential with ECl, showing that the channel is more selective for anions than cations (Ca2+, K+, tetraethylammonium+). The channel could be activated by Al3+, but not by La3+, and was observed in protoplasts isolated from the root apex but not in protoplasts isolated from mature root tissue. The anion channel antagonist niflumate inhibited the current in whole cell measurements by 83% at 100 microM. Outside-out patch recordings revealed a multistate channel with single-channel conductances of between 27 and 66 pS.