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      Experiences of advanced dementia care in seven European countries: implications for educating the workforce

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          ABSTRACT

          Background: There is a paucity of robust research concerning the care experiences of peoplewith advanced dementia within Europe. It is essential to understand these experiences if weare to address care inequalities and create impactful dementia policies to improve servicesthat support individuals and enable family caring.

          Objectives: To identify the strengths and weaknesses in daily life perceived by people with dementia and family caring across Europe by exemplifying experiences and the range of typical care settings for advanced dementia care in seven partner countries.

          Methods: Twenty two in-depth qualitative case studies were completed in seven European countries across a range of care settings considered typical within that country. Narrative accounts of care illuminated a unique set of experiences and highlighted what was working well (strengths or positive aspects) and not so well (weaknesses or negative aspects) for people with advanced dementia and family caring. A constant comparative method of analysis through thematic synthesis was used to identify the common themes.

          Results: Eight key themes were identified; Early diagnosis, good coordination between service providers, future planning, support and education for carers, enabling the person with dementia to live thebest life possible and education on advanced dementia for professional and family caregiverswere all significant and recurring issues considered important for care experiences to bepositive.

          Conclusion: People with advanced dementia may have limited opportunities for self-realization and become increasingly reliant on the support of others to maximize their health and well-being. Careful attention must be given to their psychosocial well-being, living environment and family caring to enable them to live the best life possible. Building on what the case studies tell us about what works well, we discuss the potential for integrating the findings into interprofesional learning solutions for the professional workforce across Europe to champion practice-based change.

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          Education, the brain and dementia: neuroprotection or compensation?

          The potential protective role of education for dementia is an area of major interest. Almost all older people have some pathology in their brain at death but have not necessarily died with dementia. We have explored these two observations in large population-based cohort studies (Epidemiological Clinicopathological Studies in Europe; EClipSE) in an investigation of the relationships of brain pathology at death, clinical dementia and time in education, testing the hypothesis that greater exposure to education reduces the risk of dementia. EClipSE has harmonized longitudinal clinical data and neuropathology from three longstanding population-based studies that included post-mortem brain donation. These three studies started between 1985 and 1991. Number of years of education during earlier life was recorded at baseline. Incident dementia was detected through follow-up interviews, complemented by retrospective informant interviews, death certificate data and linked health/social records (dependent on study) after death. Dementia-related neuropathologies were assessed in each study in a comparable manner based on the Consortium to Establish a Registry for Alzheimer's Disease protocol. Eight hundred and seventy-two brain donors were included, of whom 56% were demented at death. Longer years in education were associated with decreased dementia risk and greater brain weight but had no relationship to neurodegenerative or vascular pathologies. The associations between neuropathological variables and clinical dementia differed according to the 'dose' of education such that more education reduced dementia risk largely independently of severity of pathology. More education did not protect individuals from developing neurodegenerative and vascular neuropathology by the time they died but it did appear to mitigate the impact of pathology on the clinical expression of dementia before death. The findings suggest that an understanding of the mechanisms leading to functional protection in the presence of pathology may be of considerable value to society.
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            Dementia care in European countries, from the perspective of people with dementia and their caregivers.

            To investigate persons with dementia and their informal caregivers' views of inter-sectoral information, communication and collaboration throughout the trajectory of dementia care, in eight European countries.
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              How many dementia cases in France and Europe? Alternative projections and scenarios 2010-2050.

              The objective of this study is to estimate the number of dementia cases expected to occur in France and Europe over the next few decades until 2050. Our estimates are based on a model using the European incidence data for dementia by age and sex, the relative mortality risks related to dementia stratified by age classes, and the projections of mortality coefficients in the French and European general population. In France, in 2010, the number of dementia cases should reach 754000, i.e., 1.2% of the general population or 2.8% of the active population. By 2050 this number should be multiplied by 2.4, i.e., 1813000 cases, which will be 2.6% of the total population and 6.2% of the active population. In Europe this number could reach more than 6 millions in 2010 and 14 millions in 2050. The sensitivity analysis performed on French data showed that our projections were robust to the use of alternative data for incidence and relative mortality risk (variation of 5.5% and 6.5%), but very sensitive to hypotheses of evolution of mortality (variation of -22% to 29%). The approach used in our study, integrating both the dementia incidence and the mortality in the calculations, allowed us to refine the projections and stress the great sensitivity of the demographic hypotheses forecasts on the evolution of life expectancy. The likely increase is particularly important and confirms that French and European health systems must take this into account when making future plans.
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                Author and article information

                Journal
                Glob Health Action
                Glob Health Action
                ZGHA
                zgha20
                Global Health Action
                Taylor & Francis
                1654-9716
                1654-9880
                2018
                13 August 2018
                : 11
                : 1
                : 1478686
                Affiliations
                [a ] Faculty of Health Sciences, University of Alicante , Alicante, Spain
                [b ] School of Health Nursing and Midwifery, University of the West of Scotland , Hamilton, Scotland
                [c ] Universidade do Porto Faculdade de Medicina, Escola superior de Enfermagem do Porto , Portugal
                [d ] Health and Caring Sciences, Linnaeus University , Växjö, Sweden
                [e ] Faculty of Medicine, Univerzita Karlova v Praze , Czech Republic
                Author notes
                CONTACT Jorge Riquelme jrgrqlm@ 123456gmail.com Facultad de Ciencias de la Salud, Universidad de Alicante , Carretera San Vicente del Raspeig, s/n, 03690San Vicente del Raspeig, Alicante, España
                Author information
                http://orcid.org/0000-0003-2053-2808
                http://orcid.org/0000-0002-6010-208X
                http://orcid.org/0000-0001-9972-7506
                http://orcid.org/0000-0002-0847-824X
                http://orcid.org/0000-0003-2375-4174
                http://orcid.org/0000-0002-8333-2988
                http://orcid.org/0000-0001-6015-7454
                http://orcid.org/0000-0001-9660-5490
                Article
                1478686
                10.1080/16549716.2018.1478686
                6095026
                30099937
                155e2b3a-a1d5-4400-97ef-1ba5779cf6ba
                © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 September 2017
                : 15 May 2018
                Page count
                Figures: 2, Tables: 3, References: 21, Pages: 13
                Funding
                Funded by: Palliare
                Award ID: 2014-1-UK01-KA203-001819
                The project was funded by the EU Erasmus+ programme with 290.000€ and coordinated by the University of the West of Scotland, Scotland. The research was conducted within the project’s interprofessional experiential learning (IPE) solutions: equipping the qualified dementia workforce to champion evidence on informed improvement to advanced dementia care and family caring (Palliare) (2014-1-UK01-KA203-001819).
                Categories
                Original Article

                Health & Social care
                dementia,alzheimer disease,case study,caregivers,quality improvement
                Health & Social care
                dementia, alzheimer disease, case study, caregivers, quality improvement

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