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      Exploring the evidence base for how people with dementia and their informal carers manage their medication in the community: a mixed studies review

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          Abstract

          Background

          Little is known about the general medicines management issues for people with dementia living in the community. This review has three aims: firstly to explore and evaluate the international literature on how people with dementia manage medication; assess understanding of medicines management from an informal carers perspective; and lastly to understand the role that healthcare professionals play in assisting this population with medicines management.

          Methods

          A mixed studies review was conducted. Web of Knowledge, PubMed and Cochrane Library were searched post-1999 for studies that explored medicines management in people with dementia dwelling in the community, and the role healthcare professionals play in supporting medicines management in people with dementia. Following screening, nine articles were included. Data from included studies were synthesised using a convergent synthesis approach and analysed thematically to combine findings from studies using a range of methods (qualitative, quantitative and mixed methods).

          Results

          Four themes were generated from the synthesis: The nature of the disease and the effects this had on medicines management; the additional responsibilities informal carers have; informal caregivers’ knowledge of the importance of managing medication and healthcare professionals’ understanding of medicines management in people with dementia. Consequently, these were found to affect management of medication, in particular adherence to medication.

          Conclusions

          This review has identified that managing medication for people with dementia dwelling in the community is a complex task with a frequently associated burden on their informal caregivers. Healthcare professionals can be unaware of this burden. The findings warrant the need for healthcare professionals to undergo further training in supporting medicines management for people with dementia in their own homes.

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          The problem of appraising qualitative research

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            A meta-review of stress, coping and interventions in dementia and dementia caregiving

            Background There has been a substantial number of systematic reviews of stress, coping and interventions for people with dementia and their caregivers. This paper provides a meta-review of this literature 1988-2014. Method A meta-review was carried out of systematic reviews of stress, coping and interventions for people with dementia and their caregivers, using SCOPUS, Google Scholar and CINAHL Plus databases and manual searches. Results The meta-review identified 45 systematic reviews, of which 15 were meta-analyses. Thirty one reviews addressed the effects of interventions and 14 addressed the results of correlational studies of factors associated with stress and coping. Of the 31 systematic reviews dealing with intervention studies, 22 focused on caregivers, 6 focused on people with dementia and 3 addressed both groups. Overall, benefits in terms of psychological measures of mental health and depression were generally found for the use of problem focused coping strategies and acceptance and social-emotional support coping strategies. Poor outcomes were associated with wishful thinking, denial, and avoidance coping strategies. The interventions addressed in the systematic reviews were extremely varied and encompassed Psychosocial, Psychoeducational, Technical, Therapy, Support Groups and Multicomponent interventions. Specific outcome measures used in the primary sources covered by the systematic reviews were also extremely varied but could be grouped into three dimensions, viz., a broad dimension of “Psychological Well-Being v. Psychological Morbidity” and two narrower dimensions of “Knowledge and Coping” and of “Institutionalisation Delay”. Conclusions This meta-review supports the conclusion that being a caregiver for people with dementia is associated with psychological stress and physical ill-health. Benefits in terms of mental health and depression were generally found for caregiver coping strategies involving problem focus, acceptance and social-emotional support. Negative outcomes for caregivers were associated with wishful thinking, denial and avoidance coping strategies. Psychosocial and Psychoeducational interventions were beneficial for caregivers and for people with dementia. Support groups, Multicomponent interventions and Joint Engagements by both caregivers and people with dementia were generally found to be beneficial. It was notable that virtually all reviews addressed very general coping strategies for stress broadly considered, rather than in terms of specific remedies for specific sources of stress. Investigation of specific stressors and remedies would seem to be a useful area for future research. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0280-8) contains supplementary material, which is available to authorized users.
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              Lifeworld-led healthcare is more than patient-led care: an existential view of well-being.

              In this paper we offer an appreciation and critique of patient-led care as expressed in current policy and practice. We argue that current patient-led approaches hinder a focus on a deeper understanding of what patient-led care could be. Our critique focuses on how the consumerist/citizenship emphasis in current patient-led care obscures attention from a more fundamental challenge to conceptualise an alternative philosophically informed framework from where care can be led. We thus present an alternative interpretation of patient-led care that we call 'lifeworld-led care', and argue that such lifeworld-led care is more than the general understanding of patient-led care. Although the philosophical roots of our alternative conceptualisation are not new, we believe that it is timely to re-consider some of the implications of these perspectives within current discourses of patient-centred policies and practice. The conceptualisation of lifeworld-led care that we develop includes an articulation of three dimensions: a philosophy of the person, a view of well-being and not just illness, and a philosophy of care that is consistent with this. We conclude that the existential view of well-being that we offer is pivotal to lifeworld-led care in that it provides a direction for care and practice that is intrinsically and positively health focused in its broadest and most substantial sense.
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                Author and article information

                Contributors
                astonlr@aston.ac.uk
                a.hilton@hull.ac.uk
                t.moutela@aston.ac.uk
                r.l.shaw@aston.ac.uk
                +44-121-204-3002 , i.maidment@aston.ac.uk
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                18 October 2017
                18 October 2017
                2017
                : 17
                : 242
                Affiliations
                [1 ]ISNI 0000 0004 0376 4727, GRID grid.7273.1, School of Life & Health Sciences, , Aston University, ; Birmingham, UK
                [2 ]ISNI 0000 0004 0412 8669, GRID grid.9481.4, Faculty of Health Sciences, , University of Hull, ; Hull, UK
                [3 ]ISNI 0000 0004 0376 4727, GRID grid.7273.1, School of Life and Health Sciences, Aston Research Centre for Healthy Ageing (ARCHA) and Pharmacy Department, , Aston University, ; Birmingham, UK
                Author information
                http://orcid.org/0000-0003-4152-9704
                Article
                638
                10.1186/s12877-017-0638-6
                5648510
                29047339
                264dc178-718d-417f-844b-ea2e827fa779
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 31 July 2017
                : 8 October 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100002121, Pharmacy Research UK;
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Geriatric medicine
                dementia,medicines management,community,informal carers,healthcare professionals

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