| 1. |
- Annerstedt, Lena, et al.
(författare)
-
Family caregiving in dementia
- 2000
-
Ingår i: Scandinavian Journal of Public Health. - 1651-1905. ; 28:1, s. 23-31
-
Tidskriftsartikel (refereegranskat)abstract
- The burden of caregivers of patients suffering from of Alzheimer type dementia (DAT) and vascular dementia (VD) was analysed at the critical time, the “breaking-point”, when home care becomes insufficient and/or inadequate and the caregiver burden has probably reached its upper limit. Primary family caregivers of 39 DAT and 40 VD patients who were being considered for relocation into group-living units were studied. Total caregiving burden and different aspects of the burden: general strain, isolation, disappointment, and emotional involvement, were correlated with the patients’ diagnoses, abilities, and symptoms. Closer kinship to the patient imposed a heavier burden. The caregiver’s gender, social class, and previous institutionalization of the patient did not influence the caregiver burden. There was no significant correlation between the patients’ ADL ability or cognition and the burden. A higher level of disappointment was found among the VD carers. Different symptomatology in patients of the two diagnostic groups was related to special aspects of the burden. Multiple regression analysis showed that the amount of caregiving time each week and impaired sense of own identity, misidentifications, clinical fluctuations, and nocturnal deterioration in the patients predicted the breaking-point.
|
|
| 2. |
- Elmståhl, Sölve, et al.
(författare)
-
Behavioral disturbances and pharmacological treatment of patients with dementia in family caregiving : A 2-year follow-up
- 1998
-
Ingår i: International Psychogeriatrics. - 1041-6102. ; 10:3, s. 239-252
-
Tidskriftsartikel (refereegranskat)abstract
- Behavioral disturbances are common in dementia. Polypharmacy due to progression of disease and fluctuation of symptoms among patients might increase risk of overtreatment and/or undertreatment. Drug prescription habits were studied in relationship to symptoms of dementia after relocation of patients to group-living care units (GC). Seventy-six demented patients (mean age 81 years) were assessed before, 12 months after, and 24 months after relocation to GC. Vascular dementia was found in 47%, Alzheimer's dementia in 46%, and other dementias in 7%. Medications, regular or as required, were recorded from medication lists. Repeated observations of symptoms like depressive mood and lack of vitality were made with validated scales. Eighty percent of the patients were prescribed drugs; 40% were given neuroleptics and 9% were given antidepressants. During the 2-year follow-up, polypharmacy increased; patients with five drugs or more increased from 15% to 35%; usage of neuroleptics or sedatives, as required, increased from 8% to 25%, p < .01. Depressive mood was noted in 86% after 2 years and 74% showed aggressiveness and anxiety, but only 12% of the patients with depressive symptoms were on antidepressants. Analgesics were prescribed to 26% of patients. In conclusion, a high proportion of patients with dementia had depressive mood and undertreatment of depressive disorder might be suspected. Polypharmacy increased during the 2-year follow-up; this finding calls for careful monitoring of adverse drug reactions, because of the deteriorating cognitive function of these patients.
|
|
| 3. |
- Elmståhl, Sölve, et al.
(författare)
-
Caregiver's burden of patients 3 years after stroke assessed by a novel caregiver burden scale
- 1996
-
Ingår i: Archives of Physical Medicine and Rehabilitation. - 0003-9993 .- 1532-821X. ; 77:2, s. 177-182
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess burden of caregivers to stroke patients three year after a primary stroke and to test validity and reliability of a novel caregiver burden scale (CB scale). Design: A longitudinal community-based 3- year follow-up study of 35 consecutive primary stroke patients initially admitted to an Acute Medical Unit (mean age 82yr). The validity of the CB scale was studied in 150 patients (mean age 77yr):83 demented outpatients assessed for need of group living and 67 outpatients with stroke from a general geriatric day-care unit. Reliability was studied in another 23 outpatients (mean age 72yr) with stroke from the same unit. Methods: A 22- item CB scale for different types of caregiver burden and scales for neuroticism and extroversion (Eysenck Personality Inventory) and quality of life (11-item scale). Activities of daily life were assessed by a 6-item scale, initially and 3 years later. Outcome Measure: Reliability and validity of the CB scale. Improvements of activities of daily life of stroke patients. Results: Factor analyses of the CB scale gave five indices-general strain, isolation, disappointment, emotional involvement, and environment-having good kappa values, .89 to 1.00 and Cronbach's alpha, .70 to .87, except for environment. A higher burden was related to a closer relationship but not to the living situation. The highest caregiver burden was found among patients showing the greatest improvements of ADL, when divided into tertiles. The patient's degree of extroversion and quality of life were negatively correlated to caregiver burden, -.46 (p < .05) and .59 (p < .01). Conclusions: The CB scale proved to be a valid and reliable instrument to assess caregiver burden. To improve the caregiver situation, individual patient personality characteristics, like extroversion, feeling of quality of life, and progression of the disease, must be considered.
|
|
| 4. |
- Elmståhl, Sölve, et al.
(författare)
-
Family caregiving in dementia : Prediction of caregiver burden 12 months after relocation to group-living care
- 1998
-
Ingår i: International Psychogeriatrics. - 1041-6102. ; 10:2, s. 127-146
-
Tidskriftsartikel (refereegranskat)abstract
- The strain of caregiving associated with the care of demented persons living at home often continues after relocation, and group-living-care units (GL), designed for a small number of subjects, have been developed. The aim was to prospectively describe caregiver burden in relationship to symptoms of patients with dementia after relocation to GL. Sixty-four caregivers and 64 demented patients were assessed before, 6 months after, and 12 months after relocation. Thirty-six caregivers were children, 7 were spouses, and 21 were others. Validated scales were used for caregiver burden and dementia symptoms. Total burden of caregivers decreased after 12 months, but the degree of isolation was unchanged and feeling of disappointment increased significantly. The burden was not related to changes of activities of daily life or disorientation. Patients' lack of vitality at relocation independently predicted caregiver's burden 1 year later. Hallucinations and changes of symptoms during the first year were associated with less caregiver burden, probably due to greater detachment of the relationship. The caregiver burden remains 1 year after relocation and any support to the caregiver should consider patients' symptoms, especially lack of vitality.
|
|
| 5. |
- Elmståhl, Sölve, et al.
(författare)
-
How should a group living unit for demented elderly be designed to decrease psychiatric symptoms?
- 1997
-
Ingår i: Alzheimer Disease and Associated Disorders. - : Ovid Technologies (Wolters Kluwer Health). - 0893-0341. ; 11:1, s. 47-52
-
Tidskriftsartikel (refereegranskat)abstract
- The main objectives were to study relationships between the design of group living (GL) units and psychiatric symptoms in demented patients before, 6 months after, and 1 year after admission to GL units. The study population comprised 105 demented elderly (83 ± 6 years), 37% with dementia of Alzheimer's type and 58% with vascular dementia. The patients were relocated by the municipal care planning team after clinical examination. An observational scale (the Organic Brain Syndrome scale) was used to assess confusional symptoms and disorientation. The physical environment was assessed by an architect using the Therapeutic Environment Screening Scale, which evaluates general design, space, lighting, noise, communication area, floor plan, and related factors. Less than 15% of the patients had no signs of dyspraxia, hallucinosis, dysphasia, or depression at admission, whereas 66% or more reported lack of vitality, aggressiveness, or restlessness. Fourteen out of 18 units had a corridor-like design (group A), one unit an L-shaped design (group B), and the others a square or H-shaped design (group C). Patients living in the B unit had less disorientation than the others at the 6-month follow-up. After 1 year, the patients in the A units had more dyspraxia, lack of vitality, and disorientation of identity. The communication areas in the units were negatively associated with 'disorientation for recent memory' and 'lack of vitality,' adjusted for type of dementia (r = -0.13 to -0.16). The size of the activity area, indoor public rooms in square meters, was not correlated to confusional reactions and disorientation. In conclusion, a GL unit design that facilitates perception without reducing the communication area is to be preferred.
|
|
| 6. |
|
|
| 7. |
- Samuelsson, Ann Margret, et al.
(författare)
-
Burden of responsibility experienced by family caregivers of elderly dementia sufferers : Analyses of strain, feelings and coping strategies
- 2001
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 15:1, s. 25-33
-
Tidskriftsartikel (refereegranskat)abstract
- Eight family caregivers of elderly dementia sufferers participated in in-depth interviews regarding their experiences of giving care. They were selected according to strain, isolation, disappointment and emotional involvement, measured on a 'caregiver burden' scale. Structural analyses of the interviews identified six categories reflecting the feelings and experiences of the caregivers. The first symptom of dementia noted by caregiving husbands was a change in personality, whereas other relatives first observed impaired memory. The dementia sufferers were deemed to be helpless, vulnerable and anxious. The quality of the relationship preceding the onset of dementia had a bearing on the carer's situation. All caregivers felt a heavy burden, especially early in the dementia process. Husbands sustained the heaviest burden; they expressed anger, worry, weariness, guilt, distress and isolation. The caregivers used different problem- and emotion-focused strategies to cope with their situation. Visits to the homes of the elderly, for instance by the district nurse or home help, which should include interviews with close relatives, are recommended in order to disclose early signs of dementia and to prepare further individual support for the family caregivers and their relatives suffering from dementia.
|
|
| 8. |
- Zhao, Chenyan, et al.
(författare)
-
Quantifying combined effects of colistin and ciprofloxacin against Escherichia coli in an in silico pharmacokinetic-pharmacodynamic model
- 2024
-
Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 14:1
-
Tidskriftsartikel (refereegranskat)abstract
- Co-administering a low dose of colistin (CST) with ciprofloxacin (CIP) may improve the antibacterial effect against resistant Escherichia coli, offering an acceptable benefit-risk balance. This study aimed to quantify the interaction between ciprofloxacin and colistin in an in silico pharmacokinetic-pharmacodynamic model from in vitro static time-kill experiments (using strains with minimum inhibitory concentrations, MICCIP 0.023–1 mg/L and MICCST 0.5–0.75 mg/L). It was also sought to demonstrate an approach of simulating concentrations at the site of infection with population pharmacokinetic and whole-body physiologically based pharmacokinetic models to explore the clinical value of the combination when facing more resistant strains (using extrapolated strains with lower susceptibility). The combined effect in the final model was described as the sum of individual drug effects with a change in drug potency: for ciprofloxacin, concentration at half maximum killing rate (EC50) in combination was 160% of the EC50 in monodrug experiments, while for colistin, the change in EC50 was strain-dependent from 54.1% to 119%. The benefit of co-administrating a lower-than-commonly-administrated colistin dose with ciprofloxacin in terms of drug effect in comparison to either monotherapy was predicted in simulated bloodstream infections and pyelonephritis. The study illustrates the value of pharmacokinetic-pharmacodynamic modelling and simulation in streamlining rational development of antibiotic combinations.
|
|
| 9. |
|
|
