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Carers’ experiences of timely access to and use of dementia care services in eight European countries

Published online by Cambridge University Press:  16 September 2019

Hannah Jelley*
Affiliation:
Dementia Services Development Centre Wales, Bangor University, Bangor, UK
Liselot Kerpershoek
Affiliation:
Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
Frans Verhey
Affiliation:
Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
Claire Wolfs
Affiliation:
Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
Marjolein de Vugt
Affiliation:
Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
Anja Bieber
Affiliation:
Institute for Health Care and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
Astrid Stephan
Affiliation:
Institute for Health Care and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
Gabriele Meyer
Affiliation:
Institute for Health Care and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
Mona Michelet
Affiliation:
Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway Faculty of Medicine, University of Oslo, Oslo, Norway Department of Geriatric Medicine, Oslo University Hospital, OsloNorway
Geir Selbaek
Affiliation:
Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway Faculty of Medicine, University of Oslo, Oslo, Norway Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
Britt-Marie Sjölund
Affiliation:
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Department of Health and Caring Services, University of Gävle, Gävle, Sweden
Anders Sköldunger
Affiliation:
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
Louise Hopper
Affiliation:
School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
Kate Irving
Affiliation:
School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
Maria Marques
Affiliation:
CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
Maria Conceição Balsinha
Affiliation:
CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal USF Marginal, São João do Estoril, Portugal
Manuel Gonçalves-Pereira
Affiliation:
CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
Daniel Michael Portolani
Affiliation:
Alzheimer Research Unit, Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
Orazio Zanetti
Affiliation:
Alzheimer Research Unit, Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
Bob Woods
Affiliation:
Dementia Services Development Centre Wales, Bangor University, Bangor, UK
*
*Corresponding author. Email: [email protected]

Abstract

Timely access to care services is crucial to support people with dementia and their family carers to live well. Carers of people with dementia (N = 390), recruited from eight countries, completed semi-structured interviews about their experiences of either accessing or not using formal care services over a 12-month period in the Access to Timely Formal Care (Actifcare) study. Participant responses were summarised using content analysis, categorised into clusters and frequencies were calculated. Less than half of the participants (42.3%) reported service use. Of those using services, 72.8 per cent reported timely access and of those not using services 67.2 per cent were satisfied with this situation. However, substantial minorities either reported access at the wrong time (27.2%), or feeling dissatisfied or mixed feelings about not accessing services (32.8%). Reasons for not using services included use not necessary yet, the carer provided support or refusal. Reasons given for using services included changes in the condition of the person with dementia, the service's ability to meet individual needs, not coping or the opportunity to access services arose. Facilitators and barriers to service use included whether participants experienced supportive professionals, the speed of the process, whether the general practitioner was helpful, participant's own proactive attitude and the quality of information received. To achieve timely support, simplified pathways to use of formal care services are needed.

Type
Article
Copyright
Copyright © Cambridge University Press 2019

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References

Alzheimer's Disease International (2015) World Alzheimer Report. The Global Impact of Dementia: An Analysis of Prevalence, Incidence, Cost and Trends. Available at https://www.alz.co.uk/research/world-report-2015.Google Scholar
Andersen, R (1968) A Behavioural Model of Families’ Use of Health Services. Chicago, IL: University of Chicago.Google Scholar
Andersen, RM (1995) Revisiting the behavioural model and access to medical care: does it matter? Journal of Health and Social Behaviour 36, 1-10.CrossRefGoogle ScholarPubMed
Biegel, DE, Bass, DM, Schulz, R and Morycz, R (1993) Predictors of in-home and out-of-home service use by family caregivers of Alzheimer's disease patients. Journal of Aging and Health 5, 419-438.CrossRefGoogle ScholarPubMed
Blackstock, KL, Innes, A, Cox, S, Smith, A and Mason, A (2006) Living with dementia in rural and remote Scotland: diverse experiences of people with dementia and their carers. Journal of Rural Studies 22, 161-176.CrossRefGoogle Scholar
Broda, A, Bieber, A, Meyer, G, Hopper, L, Joyce, R, Irving, K, Zanetti, O, Portolani, E, Kerpershoek, L, Verhey, F, de Vugt, M, Wolfs, C, Eriksen, S, Røsvik, J, Marques, MJ, Gonçalves-Pereira, M, Sjölund, BM, Woods, B, Jelley, H, Orrell, M, Stephan, A and the Actifcare Consortium (2017) Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries. BMC Health Services Research 17, 1-14.CrossRefGoogle ScholarPubMed
Brodaty, H and Donkin, M (2009) Family caregivers of people with dementia. Dialogues in Clinical Neuroscience 11, 217-228.Google ScholarPubMed
Brodaty, H, Thomson, C, Thompson, C and Fine, M (2005) Why caregivers of people with dementia and memory loss don't use services. International Journal of Geriatric Psychiatry 20, 537-546.CrossRefGoogle ScholarPubMed
Bruce, DG and Paterson, A (2000) Barriers to community support for the dementia carer: a qualitative study. International Journal of Geriatric Psychiatry 15, 451-457.3.0.CO;2-K>CrossRefGoogle ScholarPubMed
Buono, MD, Busato, R, Mazzetto, M, Paccagnella, B, Aleotti, F, Zanetti, O, Bianchetti, A, Trabucchi, M and De Leo, D (1999) Community care for patients with Alzheimer's disease and non-demented elderly people: use and satisfaction with services and unmet needs in family caregivers. International Journal of Geriatric Psychiatry 14, 915-924.3.0.CO;2-H>CrossRefGoogle Scholar
Franz, CE, Barker, JC, Kim, K, Flores, Y, Jenkins, C, Kravitz, RL and Hinton, L (2010) When help becomes a hindrance: mental health referral systems as barriers to care for primary care physicians treating patients with Alzheimer's disease. American Journal of Geriatric Psychiatry 18, 576-585.CrossRefGoogle ScholarPubMed
Górska, S, Forsyth, K, Irvine, L, Maciver, D, Prior, S, Whitehead, J, Flockhart, J, Fairnie, J and Reid, J (2013) Service-related needs of older people with dementia: perspectives of service users and their unpaid carers. International Psychogeriatics 25, 1107-1114.CrossRefGoogle ScholarPubMed
Greenwood, N and Smith, R (2015) Barriers and facilitators for male carers in accessing formal and informal support: a systematic review. Maturitas 82, 162-169.CrossRefGoogle ScholarPubMed
Harwood, RH, Sayer, AA and Hirschfield, M (2004) Current and future worldwide prevalence of dependency, its relationship to total population, and dependency ratios. Bulletin of the World Health Organization 82, 251-258.Google ScholarPubMed
Hinton, L, Franz, CE, Reddy, G, Flores, Y, Kravitz, RL and Barker, JC (2007) Practice constraints, behavioral problems, and dementia care: primary care physicians’ perspectives. Journal of General Internal Medicine 22, 1487-1492.CrossRefGoogle ScholarPubMed
Keady, J, Clarke, CL and Adams, T (eds) (2003) Community Mental Health Nursing and Dementia Care: Practice Perspectives. Maidenhead, UK: Open University Press.Google Scholar
Kempen, GI and Suurmeijer, TP (1991) Professional home care for the elderly: an application of the Andersen-Newman model in The Netherlands. Social Science & Medicine 33, 1081-1089.CrossRefGoogle ScholarPubMed
Kerpershoek, L, de Vugt, M, Wolfs, C, Jelley, H, Orrell, M, Woods, B, Stephan, A, Bieber, A, Meyer, G, Engedal, K, Selbaek, G, Handels, R, Wimo, A, Hopper, L, Irving, K, Marques, M, Gonçalves-Pereira, M, Portolani, E, Zanetti, O, Verhey, F and the Actifcare Consortium (2016) Access to timely formal dementia care in Europe: protocol of the Actifcare (ACcess to Timely Formal Care) study. BMC Health Services Research 16, 1-7.Google ScholarPubMed
Lawton, M, Brody, E and Saperstein, A (1989) A controlled study of respite service for caregivers of Alzheimer's disease patients. The Gerontologist 29, 8-16.CrossRefGoogle Scholar
Leon, J, Neumann, PJ, Hermann, RC, Hsu, MA, Cummings, JL, Doraiswamy, PM and Marin, D (2000) Health-related quality-of-life and service utilization in Alzheimer's disease: a cross-sectional study. American Journal of Alzheimer's Disease 15, 94-108.CrossRefGoogle Scholar
Macleod, A, Tatangelo, G, McCabe, M and You, E (2017) ‘There isn't an easy way of finding the help that's available.’ Barriers and facilitators of service use among dementia family caregivers: a qualitative study. International Psychogeriatrics 29, 765-776.CrossRefGoogle ScholarPubMed
MaloneBeach, EE, Zarit, SH and Spore, DL (1992) Caregivers perceptions of case management and community-based services: barriers to service use. Journal of Applied Gerontology 11, 146-159.CrossRefGoogle ScholarPubMed
Mayring, P (2014) Qualitative Content Analysis: Theoretical Foundation, Basic Procedures and Software Solution. Klagenfurt, Austria. Available at http://nbn-resolving.de/urn:nbn:de:0168-ssoar- 395173.Google Scholar
Menne, HL and Whitlatch, CJ (2007) Decision-making involvement of individuals with dementia. The Gerontologist 47, 810-819.CrossRefGoogle ScholarPubMed
Molyneaux, VJ, Butchard, S, Simpson, J and Murray, C (2012) The co-construction of couplehood in dementia. Dementia: The International Journal of Social Research and Practice 11, 483-502.CrossRefGoogle Scholar
National Institute for Health and Care Excellence (2018) Dementia: Assessment, Management and Support for People Living with Dementia and Their Carers. Available at https://www.nice.org.uk/guidance/ng97.Google Scholar
Phillipson, L, Jones, SC and Magee, C (2014) A review of the factors associated with the non-use of respite services by carers of people with dementia: implications for policy and practice. Health & Social Care in the Community 22, 1-12.CrossRefGoogle ScholarPubMed
Robinson, KM, Buckwalter, KC and Reed, D (2005) Predictors of use of services among dementia caregivers. Western Journal of Nursing Research 27, 126-140.CrossRefGoogle ScholarPubMed
Stephan, A, Bieber, A, Hopper, L, Joyce, R, Irving, K, Zanetti, O, Portolani, E, Kerpersheroek, L, Verhey, F, de Vugt, M, Wofls, C, Eriksen, S, Røsvik Marques, MJ, Gonçalves-Pereira, M, Sjölund, BM, Jelley, H, Woods, B, Meyer, G and on behalf of the Actifcare Consortium (2018) Barriers and facilitators to the access to and use of formal dementia care: findings of a focus group study with people with dementia, informal carers and health and social care professionals in eight European countries. BMC Geriatrics 18, 1-16.CrossRefGoogle ScholarPubMed
Stewart, TV, Loskutova, N, Galliher, JM, Warshaw, GA, Coombs, LJ, Staton, EW, Huff, JM and Pace, WD (2014) Practice patterns, beliefs, and perceived barriers to care regarding dementia: a report from the American Academy of Family Physicians (AAFP) National Research Network. Journal of the American Board of Family Medicine 27, 275-283.CrossRefGoogle ScholarPubMed
Svanberg, E, Stott, J and Spector, A (2010) ‘Just helping’: children living with a parent with young onset dementia. Aging & Mental Health 14, 740-751.CrossRefGoogle ScholarPubMed
Thyrian, JR and Hoffmann, W (2012) Dementia care and general physicians – a survey on prevalence, means, attitudes and recommendations. Central European Journal of Public Health 20, 270-275.CrossRefGoogle ScholarPubMed
Tucker, S, Hughes, J, Burns, A and Challis, D (2008) The balance of care: reconfiguring services for older people with mental health problems. Aging & Mental Health 20, 81-91.CrossRefGoogle Scholar
Vetter, P, Steiner, O, Kraus, S, Moises, H, Kropp, P, Moller, WD and Kohler, O (1998) Factors affecting the utilization of homecare support by caregiving relatives of Alzheimer patients. Dementia and Geriatric Cognitive Disorders 9, 111-116.CrossRefGoogle ScholarPubMed
Vroomen, JM, Bosmans, JE, van Hout, HP and de Rooij, SE (2013) Reviewing the definition of crisis in dementia care. BMC Geriatrics 13, 1-12.CrossRefGoogle Scholar
Walters, K, Iliffe, S and Orrell, M (2001) An exploration of help-seeking behaviour in older people with unmet needs. Family Practice 18, 277-282.CrossRefGoogle ScholarPubMed
Werner, P, Goldstein, D, Karpas, D, Chan, L and Lai, C (2014) Help-seeking for dementia: a systematic review of the literature. Alzheimer Disease and Associated Disorders 28, 299-310.CrossRefGoogle ScholarPubMed
Winslow, BW (2003) Family caregivers’ experiences with community services: a qualitative analysis. Public Health Nursing 20, 341-348.CrossRefGoogle ScholarPubMed
Wolfs, CAG, de Vugt, ME, Verkaaik, M, Verkade, PJ and Verhey, FRJ (2010) Empowered or overpowered? Service use, needs, wants and demands in elderly patients with cognitive impairments. International Journal of Geriatric Psychiatry 25, 1006-1012.CrossRefGoogle ScholarPubMed
Woods, B, Arosio, F, Diaz, A, Gove, D, Holmerova, I, Kinnaird, L, Mátlová, M, Okkonen, E, Possenti, M, Roberts, J, Salmi, A, van den Buuse, S, Werkman, W and Georges, J (2018) Timely diagnosis of dementia? Family carers’ experiences in 5 European countries. International Journal of Geriatric Psychiatry 34, 114-121.CrossRefGoogle ScholarPubMed
World Health Organization (2017) Global Action Plan on the Public Health Response to Dementia 2017–2025. Licence: CC BY-NC-SA 3.0 IGO. Available at http://apps.who.int/iris/bitstream/10665/259615/1/9789241513487-eng.pdf?ua=1.Google Scholar
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