The development of healthcare services for dementia is key to improving access to care and post-diagnostic support for people living with dementia. Memory Units have emerged as a new healthcare service composed of multidisciplinary teams with the goal of improving diagnosis and/or management of dementia patients. The main objective of this study was to describe and evaluate the Reach and Effectiveness of a Memory Unit in a public hospital in Chile, using the RE-AIM model, a multi-component model that allows for the evaluation of the implementation of ongoing healthcare programs. Regarding “R” (Reach): from March 2018 up to June 2019, a total of 510 patients were referred and assessed. Most patients came from primary care (51.9%) and from outpatient services at the Hospital Salvador (39.2%), particularly from the Neurology (63.3%) and Psychiatry (16.0%) departments. We estimated that our Memory Unit assessed 5.39% of all of the dementia patients living in the area of referral. With respect to “E” (Effectiveness): 419 patients are still being followed up at the Memory Unit. Ninety-one patients (18%) were discharged. Of these, 55 (66%) were referred to primary healthcare, 28 (31%) to other outpatient services, 9 (10%) to a specialized mental healthcare center, and 9 (10%) to a daycare center. Due to the short period of time that the Memory Unit has been operating, no other RE-AIM dimensions could be evaluated at this juncture. To our knowledge, this is the first implementation study of a Memory Unit in Latin America, and the first using the RE-AIM model. Although cultural differences worldwide might play a role in the lack of international guidelines, the publication of the experience of the first year of this unit in Chile could inform new countries about this process. Ongoing challenges include continuing to collect data to complement the RE-AIM evaluation and developing a protocol that can be adopted elsewhere in Chile and Latin America. Further studies are needed to assess the benefits of a Memory Unit in comparison to regular care and to develop a model that assures continuity and coordination of care for people with dementia.
Background: During the COVID-19 pandemic, loneliness has increased in the general population due to government measures to contain the spread of the disease. In Latin America (LA), caregiving is most often delivered informally by family members Family caregivers often face mental health challenges linked to their caregiving role and their social context. Pandemic-related social restrictions have been especially detrimental for older people with dementia or other brain health challenges, as well as their family caregivers. We aimed to investigate the associations of loneliness, social isolation and care burden in these family caregivers. Method:We undertook a cross-sectional survey of over 300 informal caregivers of people with dementia or enduring mental health problems living in 4 Latin American countries, Mexico, Brazil, Chile, and Peru. We categorized loneliness into 3 groups 'low' , 'moderate' and 'severe loneliness' . Here, we analyzed factors related to changes in the prevalence of moderate and severe loneliness before and during the pandemic using a longitudinal multinomial logistic regression model.Result: During the pandemic, there was a significant increase in loneliness prevalence (p<.001) among caregivers in Latin America, with more people having moderate (6.25% pre-pandemic; 17.67% mid-pandemic) and severe loneliness (2.78% pre-pandemic; 15.19% mid-pandemic). Gender differences in the prevalence of loneliness or higher levels of loneliness among dementia caregivers compared to caregivers of other conditions were not seen. The regression model revealed that the increment in risk for moderate loneliness during the pandemic was related to caregivers' age, level of education, and social contact/isolation. Increased risk for severe loneliness was related to caregivers' social contact during the pandemic and perceived mental health.
The prevalence of dementia in Chile is 1.06 %, meaning that over 200,000 people are affected. In 2017, the Ministry of Health launched the National Plan of Dementia, which proposed establishing a range of health-care services from primary care to Memory Units (MU).MUs have emerged as a new health care service composed of multidisciplinary teams with the goal of improving diagnosis and management of dementia patients.The creation and implementation of a MU should take into consideration the organization of a particular healthcare system. In this context, the evaluation of a Chilean MU might provide information for the standardization and replication of such a health service on a regional basis.The objective of this paper was to evaluate the implementation processes of a MU using the RE-AIM model, a multi-component model aimed to assist the evaluation of the implementation of ongoing programs.Regarding “R” (Reach): from March 2018 up to June 2019, a total of 510 patients were referred and assessed at the Hospital del Salvador. Most patients came from primary care (51.9 %) and from outpatient services at the Hospital (39.2 %), particularly from the Neurology (63.3%) and Psychiatry (16.0 %) departments. We estimated that the MU assessed 5.39% of dementia patients living in the area of referral.In relationship with “E” (Effectiveness): of patients evaluated by the MU, 60 (11%) were discharged. Of these, 41 (66%) were referred to primary health care, 9 (17%) to other outpatient services, 6 (10%) to a specialized mental health care center, and 4 (7%) to a daycare center.Due to the short lifespan of our MU, no other RE-AIM dimensions could be evaluated yet.This was the first evaluation of the implementation of a MU in Chile as part of the Chilean Dementia Plan. It showed that it is possible to implement a MU in a Latin American country and improve access to dementia diagnosis, management, and treatment. Ongoing challenges include continuing to collect clinical data, creating research projects as part of the MU, and developing a MU protocol that can be adopted elsewhere in Chile and other Latin American countries.
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