What happens before, during and after crisis for someone with dementia living at home: A systematic review

Abstract

BackgroundPeople living with dementia often experience crisis. Home treatment of crisis is an alternative to hospital admission that can have better outcomes. This systematic review is about people with dementia living at home and in crisis. It identifies modifiable factors in the crisis process that may facilitate crisis resolution. MethodsThe protocol is registered on PROSPERO. A systematic search of MEDLINE, EMBASE, CINAHL, AHMED, PsycINFO, Cochrane Library, and references of retrieved publications, identified empirical research in English language and date range 1/2000 to 2/2019. Two researchers independently screened abstracts, selected publications and extracted data using a framework based on published guidelines. This is a report of the analysis and narrative synthesis. ResultsThe search identified 2,755 titles and abstracts, 76 were selected for full-text examination and 13 agreed for inclusion. The included studies evidence that:For a person with dementia, crisis is a process that begins with a problem judged to put them or others at risk of harm. It leads to decision and action to treat this risk, thus resolve the crisis. Such crisis can be predicted or unpredicted and progress quickly or slowly.Medical treatment, community resources, and psychosocial support of personal resources, decision making, relationships, and social networks, are all modifiable factors that can treat the risk of harm during crisis. Carers' and professionals' knowledge and skills in dementia care are likely to play a key role in crisis resolution in the home. ConclusionThere has been limited investigation of the process and management of crisis at home for people living with dementia. The results of this review provide a foundation for future research. There is no consensus on critical components of home treatment to facilitate crisis resolution. However, education in dementia care for carers and professionals is likely to prove essential to successful home treatment.

A Systematic Review of the Needs of Dementia Caregivers Across Care Settings

“…Caregivers’ needs identified in the domain of formal social support largely align with existing literature, particularly in regard to lack of access to formal services, information about dementia, and availability of dementia care training. 6,9,53,54 Existing literature does not specifically highlight the need for improved communication with providers. However, some commonly identified formal support needs, such as for more dementia-related information and education, may encompass caregivers’ needs for improved communication.…”

“…6,54 For the domain of caregiver confidence, competence, and strengths, existing literature does not specifically identify caregiver needs in relation to confidence or competence, but it does identify their need to acquire knowledge, skills, and health literacy to support their caregiving role. 8,9,53,54 Existing literature also does not specifically highlight the need for validation of caregivers' knowledge or skills, which may be a need that has been largely overlooked. In regard to balancing personal needs and responsibilities with their caregiving role, this is reflected in the literature as a caregiver need.…”

Positionspapier der Österreichische Alzheimer Gesellschaft (ÖAG)

“…If the crisis is not resolved, the cycle continues.“ Trotz dem neu hinzugekommenen Stressor „COVID-19“ hat diese Definition auch für die rezente Krise nicht an Aktualität verloren. Auch in einer aktuell 2020 publizierten Übersichtsarbeit zum Management von Krisen bei Patienten mit Demenz wurde ein Mangel an entsprechenden Studien und die Notwendigkeit der Entwicklung klarer Krisenkonzepte schlussgefolgert [ 13 ]. Als vorrangiges Ziel in den genannten Studien wurde angeführt, Akutaufnahmen und den Transfer an Notfallaufnahmen von Menschen mit Demenz zu vermeiden und ein effektives Krisenmanagement für die Patienten in gewohnter Umgebung zu ermöglichen [ 14 ].…”

Crisis management for people with dementia at home: Mixed‐methods case study research to identify critical factors for successful home treatment

“…Home treatment of crisis can reduce hospital admission rates for people with dementia (Toot, Devine, & Orrell, 2011) but, crisis service provision is variable, with different hours of service provision and service models, and no provision in some geographical locations (Lloyd‐Evans et al., 2018; Streater et al., 2017). There is limited empirically based knowledge of the process and management of crisis in the home (Hopkinson et al., 2020).…”