OAR@UM Community: Previously known as Department of Gerontology
https://www.um.edu.mt/library/oar/handle/123456789/446
Previously known as Department of Gerontology2024-03-29T14:20:58ZThe development and evaluation of an informal caregivers’ communication training in community dementia care : a pilot study
https://www.um.edu.mt/library/oar/handle/123456789/119371
Title: The development and evaluation of an informal caregivers’ communication training in community dementia care : a pilot study
Abstract: Background: Communication, as a major component of brain function impacted by dementia, progressively deteriorates self-expression abilities. This not only strains the relationship between the person living with dementia (pLwD) and the informal caregivers, but also their wellbeing and quality of life, while increasing caregiver burden. With impaired self-expression, the pLwD may use other means of communication which may be interpreted as ‘challenging behaviour’. Informal caregivers feel they lack competence in handling such behaviours, further contributing to caregiver burden and unmet needs of the pLwD. To date, training on effective communication in dementia care was mostly offered to formal caregivers i.e., healthcare professionals, working within healthcare or residential care settings.
Aim: To develop and evaluate a pilot communication training programme, based on the PACTM dementia care approach by Ms. Teepa Snow, targeting informal caregivers of community-dwelling people living with dementia (PLwD).
Methodology: A mixed-method approach was used to investigate the impact of pilot communication training on informal caregivers, mainly caregiver burden and self-efficacy. Quantitative outcomes were gathered via online questionnaires at pre-, post-intervention and at follow-up after two months from completion of the training programme. Four sessions of two-hours each were delivered to informal caregivers online. Questionnaires included the following standardised assessments: The Communication Problems Scale, The Caregiver Burden Assessment, The Revised Memory and Behaviour Assessment, and The Communication Self-Efficacy Scale – all measuring outcomes using a 5-point Likert Scale. Informal caregivers were recruited from the Dementia Intervention Team, which provides community dementia services. A total of ten initial participants who later dropped to eight (3 males ; 5 females) completed the whole data collection process. Qualitative outcomes were gathered via online recorded focus groups, and were analysed using thematic analysis by Clarke & Braun (2013). One participant completed the training and questionnaires remotely. Caregivers had access to recorded sessions and were given recapitulating material at the end of each session.
Results: Most of the caregivers were femals – daughters of the pLwD, not living with the pLwD, and employed. Data gathered on caregiver burden showed that caregivers mostly experience tension (subjective stress burden), with these being higher among employed caregivers. Caregivers also reported having less time for themselves, friends or other family members, less time to spend in recreational activities, and less time for doing their own daily chores or work (objective burden). However, after the training these components of caregiver burden recorded improvement with statistical significance. Caregiver communication self-efficacy also recorded improvement, but not statistically significant.
Conclusion: This pilot study provided evidence that communication training for informal dementia caregivers can support them by enhancing dementia knowledge and provide strategies for effective interaction with the pLwD, despite the impaired communication skills. This enhances the wellbeing of both and enables caregivers to handle challenging situations better.
Description: M.A.(Melit.)2023-01-01T00:00:00ZInformal caregivers’ perspectives on the role of the environment on older persons living with dementia within a long-term care facility in Malta
https://www.um.edu.mt/library/oar/handle/123456789/119370
Title: Informal caregivers’ perspectives on the role of the environment on older persons living with dementia within a long-term care facility in Malta
Abstract: Older persons living with dementia have lower thresholds for stress tolerance with regards to environmental stimuli which in turn results in dysfunctional behaviours and difficulty with performing activities of daily living. It is well recognised that the environment has an important role in the care of older persons living with dementia and that environmental modifications within long-term care facilities could better meet their needs. The purpose of this study was to get an in-depth understanding of informal caregivers’ perspectives on the influence of the physical and social aspects of the environment on older persons living with dementia within a long-term care facility in Malta. This study adopted a qualitative approach based on Interpretive Description. Data was collected through semi-structured interviews with six informal caregivers of older persons living with dementia within a long-term care facility. The researcher drew on Interpretive Description methodology and reflexive Thematic Analysis to analyse the data and generate findings. Three themes were generated: (a) social engagement, (b) supportive healthcare practices in relation to the social environment, and (c) building design in relation to the physical environment. The participants considered the social environment to be more important than the physical environment in promoting the well-being of older persons living with dementia. The two are inter-related and should complement each other to provide quality care for older persons living with dementia within long-term care facilities.
Description: M. Ger.(Melit.)2023-01-01T00:00:00ZInstitutionalised older people's experiences and perceptions of death and their attitudes towards decision-making at end of life : a qualitative study
https://www.um.edu.mt/library/oar/handle/123456789/119369
Title: Institutionalised older people's experiences and perceptions of death and their attitudes towards decision-making at end of life : a qualitative study
Abstract: End-of-life (EOL) discussions are not yet the norm across the Maltese Islands. This lack of communication of the patient’s preferences, wishes and values can lead to ethical and moral dilemmas at EOL. Research reveals that there is a willingness amongst older adults to be included in the decision-making process. Acquiring a better understanding of their subjective meanings, perceptions, and values at EOL are prerequisites in institutions to enable person-centred care and a dignified death. This study aimed to explore the experiences and perceptions of institutionalised older adults on EOL including death and their attitudes towards decision-making in this stage of life, with the introduction of Advance Care Planning (ACP) as a novel tool to safeguard their autonomy and dignity till the end. This study followed a qualitative approach, informed by an interpretative phenomenological analysis (IPA) design, in the quest to derive meaning from the participants’ lived experiences. Ethical permissions were sought and obtained from the Faculty Research Ethics Committee on the 18th of February 2022. Six cognitively preserved older adults residing in Saint Vincent de Paul – Long term care facility (SVP) were interviewed. Data was collected via individual semi structured interviews, transcribed verbatim, and translated accordingly. Data was analysed through IPA. The findings revealed that even though older adults move to an institution to safeguard their well-being or to accompany their loved ones, it may still adversely affect their sense of self and autonomy. Death and dying were mainly perceived as the inevitable outcome of life and as an opportunistic release from suffering and pain. Three modalities of suffering experiences namely, family and personal past experiences and room-mates experiences of suffering in dying did strongly affect how respondents reacted to care preferences in the EOL. Preferences and wishes for their EOL care were revealed, ranging from achieving a good and dignified death to ideas about how to terminate their life, in the face of suffering. Moreover, older adults valued autonomy differently regarding decision-making in their EOL and identified their preferred roles and that of other stakeholders in the decision-making process. In addition, their fear of losing autonomy in their EOL was emphasised, with respondents looking favourably towards the introduction of ACP as a tool to control and sustain a voice in their EOL. Death is an inevitable part of life, but the major concern amongst older adults residing in SVP is not the eventuality of death itself but rather how they approach and embrace it. The perception and experience of death and dying are subjective and EOL discussions are the way to help allay the anxiety of loss of control in the EOL, where ACP could serve as the key to translating such preferences into advance care directives that help sustain autonomy.
Description: M.A.(Melit.)2023-01-01T00:00:00ZDrug use and polypharmacy incidence in community state-run older adult care homes in Malta
https://www.um.edu.mt/library/oar/handle/123456789/119352
Title: Drug use and polypharmacy incidence in community state-run older adult care homes in Malta
Abstract: Aims & objectives: The aim and objectives of this research project was to refute or accept the initial hypothesis of excessive polypharmacy drug use and pharmaceutical drug use amongst older adults living in the four community-state-run residential care homes. The study also aspired to investigate the extent of drug-to-drug interactions/adverse effects amongst these individuals, as well as to forward a number of recommendations based on findings and suggest plausible ways for overcoming such practices.
Background: As the world continues to evolve, and people grow older, older adults are renowned to suffer from multimorbid medical conditions. Whilst the abundant world and medical industry has well been ingrained in today’s life, including the use and admittance to long-term care institution and use of pharmaceutical drug prescriptions as the first line care of practices, residential care homes are often thought to favor pharmaceutical drug prescriptions driven by the paternalistic biomedical framework, other from using for instance complementary and alternative medications (CAMs).
Method: Following a literature review both on the subject as well as quantitative research methods, the study recruited a total of 196 participants through a randomized convenience sampling techniques, 5 of which passed away during the course of the study and thus were eliminated due to the inaccessibility of data. The use of gatekeepers in the four community-state-run residential care homes (the head of homes), as well as pre-made ‘EXCEL’ sheets, were utilized to gather data. Results were later generated by the use of both ‘EXCEL’ and ‘SPSS’ programs and tests such as ‘Spearman’s’, the ‘Kruskal-Wallis test’ and ‘t-test’ were utilized accordingly.
Results: As initially hypothesized in this research project, this study has found the great majority of participants as having polypharmacy practices. Whilst the recruited participants had significant debility, necessitating treatment, the study has found little to no differences between gender effects in regard to pharmaceutical drug use and polypharmacy practices. However, residing in long-term care was common in individuals with moderate mobility that was established by the Barthel scoring, and in terms of longevity enrolled participants were generally not in a state of well-being when considering the mean number of comorbidities and level of functional deterioration found. Drug-to-drug interactions, as well as the use of the STOP/START criteria and online ‘EPOCRATES’ drug checker, were found useful tools in determining the extent of drug-to-drug interactions and plausible encountered side-effects in enrolled participants. Conclusion: The study concluded that a multidisciplinary team approach and the use of CAMs as a supplement to the traditional biomedical paternalistic framework is needed when the STOP/START criteria and online EPOCRATES web checker were utilized. Furthermore, moving toward a person-centered approach to eradicating a single-centered disease approach is needed.
Description: M.A.(Melit.)2023-01-01T00:00:00Z