Year: 2002
Type: dissertation
Study design: Clinical Trial
Abstract: Demented patients are placed in long-term institutional care at a higher rate than non-demented elderly people.In Finland, 40 to 50% of all demented patients are in long-term institutional care.This lays a heavy economic burden on the social and health care system.Managing community care of demented patients relies largely on family members, especially on spouses who are often committed to continue in caregiving even at more advanced stages of dementia.Institutional respite care may provide relief to a caregiver but often deteriorates a patient's functional capacity and may increase the risk for institutionalization.The aims of the present study were to study (1) the effects of a nurse case manager (NCM) intervention on community care of elderly people with cognitive impairment, (2) the effects of institutional respite care on demented patients' functional capacity, and (3) the influence of dementia on marriage.The Kuopio Dementia Study and the Kuopio Delirium Study were used to study the effects of NCM intervention.The main population of the Kuopio Dementia Study comprised 100 patients living in the community and receiving primary support from an informal caregiver in eastern Finland.Patients were recruited from the register of the Social Insurance Institution and randomly allocated to either the intervention (n=53) or control group (n=47).Intervention patients with their caregivers were provided with a 2-year intervention by a NCM.The intervention patients (n=51) participating in the Kuopio Delirium Study were provided with similar intervention by a NCM.In the Kuopio Dementia Study, the intervention by a NCM deferred placement in longterm institutional care.Results also suggest that the intervention used in the study may be especially beneficial to patients with severe dementia and those with problems threatening the continuity of community care.In the Kuopio Delirium Study, 67% of the intervention patients were diagnosed as having dementia in the three-year follow-up.The survival in community care was significantly longer in the intervention than in the control patients.In both studies, the need for intervention by NCMs increased remarkably when a problematic situation arose.After diagnosing the cause of the problem, the NCMs implemented measures that often requiring consultation with the study physician.To evaluate the long-term effect of the intervention by NCM, semi-structured telephone interviews were used to collect further data on all those caregivers (n=64) in the Kuopio Dementia Study who had experienced cessation of caregiving.Community care support had protected the caregivers from loneliness, depressive feelings and sorrow.An increased amount of leisure activities was associated with the intervention group.Cessation of caregiving caused more negative emotional reactions and provided less relief to the spouse than to non-spouse caregivers.To investigate influence of dementia on marriage, further data were collected by telephone interviews with the spouse caregivers in the Kuopio Dementia Study.Spouse caregivers (n=42) felt that dementia had had a major negative impact on many dimensions of their marital relationship.However, the results also indicate that some positive aspects were preserved in the marriage after the onset of dementia.In one-third of the patients, expressions of tenderness towards the caregiver had increased.Dementia did not significantly affect the general atmosphere of the marriage.Dementia seemed to have surprisingly little impact on whether the couple continued to have sexual intercourse as compared with the general aging population.To evaluate whether institutional respite care of demented patients is possible without deterioration of cognitive and functional capacity, the data of patients in respite care in two special care units (SCU), one in Helsinki and one in Vaasa were collected.The patients' MMSE scores improved significantly in both SCUs.The caregivers reported improvement in the functional capacity of 40% of the patients in SCU 1 and 26% in SCU 2. The positive changes in the patients' mood were common (in 76% and 68% of the patients in SCU 1 and SCU 2, respectively).In conclusion, NCM intervention proved to be effective in prolonging the community care of elderly people with cognitive impairment.The intervention also had long-term effects on the caregivers of demented patients and helped them to return to a normal life with an increased amount of leisure activities.The cessation of caregiving provided less relief to spouse caregivers, and even tended to give rise to negative life changes.Dementia had a major negative impact on many dimensions of marriage.However, there were also some positive changes and aspects of marriage preserved that may explain why especially spouse caregivers are often committed to continue in caregiving even at more advanced stages of dementia.
Author: Ulla Eloniemi‐Sulkava
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2133275049