Search Results (137)

Despite the extensive evidence supporting the effectiveness of cognitive stimulation, differences in results may be due to the influence of cognitive and non-cognitive aspects in people with dementia. The aim of this systematic review is to identify the most reliable variables in forecasting the effectiveness of cognitive stimulation in people with mild to moderate dementia. According to PRISMA guidelines, the research was conducted using five databases (PubMed, Scopus, Cochrane, Web of Science, APA PsycInfo), considering randomized controlled trials. A total of six studies were included. Different aspects moderating the gain resulting from cognitive intervention were collected and assessed in terms of demographic, cognitive, emotional, social, and quality of life parameters. People with dementia benefit more from cognitive intervention if they are female, if they have a low formal education level, a low baseline level of cognitive function, and lower depressive symptoms, and if caregivers actively participate in sessions. Quality of life, if low at baseline, also seems to improve following CST intervention. A deeper understanding of the cognitive and non-cognitive aspects ensuring improvement after cognitive stimulation may guide future research to develop more personalized interventions. Full article

Background: Thailand is rapidly transitioning into an aging society, creating an intergenerational caregiving gap that strains existing support systems. Objective: This study evaluated the effectiveness of “Young Care,” a community-based intervention designed to enhance youth knowledge, attitudes, and caregiving practices (KAP) toward older adults. Methods: A two-day structured training was conducted in Maha Sarakham Province in 2023 using a pre-post mixed-methods design. Middle and high school students participated in lectures, multimedia sessions, and experiential learning activities related to caregiving. Quantitative data were collected using validated KAP questionnaires, while qualitative insights were obtained from focus group discussions involving students, older persons, caregivers, and local leaders. Results: Post-intervention analysis revealed significant improvements in knowledge and attitudes (p < 0.001), accompanied by increased empathy, caregiving initiative, and a sense of moral responsibility among participants. Conclusions: The initiative fostered formal partnerships among schools, local governments, healthcare providers, and universities through memoranda of understanding. These collaborations enabled budgetary support and outreach to out-of-school youth, positioning “Young Care” as a scalable, youth-centered strategy to address Thailand’s long-term care challenges. Full article

Early childhood forest and nature education plays a vital role in shaping values and promoting sustainability throughout life. Conceptualized in Denmark, forest and nature childcare groups have been established in Austria for over 20 years, contributing to mental well-being and supporting both Education for Sustainable Development (ESD) and Early Childhood Education and Care (ECEC). With increasing demand for childcare and a growing disconnect from nature—factors linked to physical and mental health challenges—there is a pressing need to expand these groups and integrate them into formal legal frameworks. This study examines the organization, staffing, infrastructure, risk prevention, and hygiene of 79 Austrian forest and nature kindergarten groups, identifying key areas of improvement to ensure safe access for all children, including those in public childcare. A semi-standardized online survey of 72 groups was analyzed using descriptive and statistical methods, including a Spearman correlation, Kruskal–Wallis test, Chi-square test, and ANOVA. Results revealed three main infrastructure types—house, container/trailer, and tipi—with houses offering the most comprehensive facilities. The ANOVA indicated significant effects of sponsorship type (p < 0.01), caregiver numbers (p < 0.001), and their interaction (p < 0.05) on half-day care costs. Currently, legal frameworks exist only in Tyrol and Salzburg. Broader access requires standardized infrastructure and risk assessment guidelines, collaboratively developed with stakeholders, to ensure safety and inclusivity in Austrian forest and nature childcare groups. Full article

Background: Nemaline myopathy is a rare congenital neuromuscular disease associated with progressive weakness and frequent respiratory complications. In emergency situations, families often serve as the first and only responders. The aim of this study is to explore how parents in Spain care for children with nemaline myopathy during emergency situations, focusing on the clinical responses performed at home and the organizational challenges encountered when interacting with healthcare systems. Methods: A qualitative phenomenological study was conducted with 17 parents from 10 families belonging to the Asociación Yo Nemalínica. Semi-structured interviews were performed via video calls, transcribed verbatim, and analyzed using Giorgi’s descriptive method and ATLAS.ti software (version 24). Methodological rigor was ensured through triangulation, reflexivity, and member validation. Results: Four themes were identified. First, families were described as acting under extreme pressure and in isolation during acute home emergencies, often providing cardiopulmonary resuscitation and respiratory support without professional backup. Second, families managed ambiguous signs of deterioration using clinical judgment and home monitoring tools, often preventing fatal outcomes. Third, parents frequently assumed guiding roles in emergency departments due to a lack of clinician familiarity with the disease, leading to delays or errors. Finally, the transition to the Pediatric Intensive Care Unit was marked by emotional distress and rapid decision-making, with families often participating in critical choices about invasive procedures. These findings underscore the complex, multidisciplinary nature of caregiving. Conclusions: Parents play an active clinical role during emergencies and episodes of deterioration. Their lived experience should be formally integrated into emergency protocols and the continuity of care strategies to improve safety and outcomes. Full article

Objectives: This study aims to explore the experiences of bereaved family members during and after the loss of a relative in an intensive care unit (ICU) during the COVID-19 pandemic-related visitation restrictions, as well as to assess their perceptions of a nurse-led bereavement support programme. Methods: Ten participants with a relative who had died in an ICU were recruited in September 2020 during a follow-up bereavement meeting at a tertiary cardiac centre in Switzerland. Descriptive qualitative research was conducted. Face-to-face nurse-led follow-up bereavement meetings, adapted to the pandemic circumstances and conducted as semi-structured interviews, were analysed by a thematic analysis. Findings: Fifteen sub-themes and three main categories were identified. The motivation behind the family members’ participation in the meetings was to ask and learn about their experiences regarding the death of their relative during this abnormal time. The reactions to the meetings varied among the families. Many expressed that the experience of bereavement was particularly challenging and painful, and that the absence of a final farewell to their loved one, as well as the impossibility of having a formally held funeral, made the deaths harder to accept. The families appreciated the interview as it gave them clarification, information, and an awareness of the facts and the care provided, and for several of them it was also a chance to share their emotions and express any difficulties they might have encountered both during and after the patient’s death. Conclusion: The COVID-19 pandemic’s restrictions had a profound impact on families who lost a loved one in an ICU. The nurse-led bereavement support service responded to the needs of grieving families, providing valuable emotional and practical support and re-establishing a healthy relationship between the families and the caregivers that was hindered by pandemic restrictions. The study also shows that a nurse-led bereavement support service can be a valuable component of family-centred care. Full article

Background: Children with food allergies can present with paediatric feeding disorder (PFD). However, access to coordinated multidisciplinary services to support these children in Australia is inconsistent. To date, the availability of services or the perceived care needs of Australian health professionals working with this population have not been formally explored. Methods: A web-based survey was distributed to health professionals in Australia. Quantitative demographic data were summarised using descriptive statistics, and open-ended responses were analysed using content analysis. Results: The final sample comprised 98 responses, with speech pathologists representing the largest professional group (n = 39; 40%). A majority (59%) worked in hospital-based services. Open-ended responses were coded utilising content analysis. Three categories were developed including (1) service delivery, (2) intervention, and (3) resources. Services were commonly impacted by long wait times, limited staff training, and inconsistencies between hospital and community care. Additionally, mental health support was frequently reported as insufficient. Conclusions: The findings from this study underscore the need for integrated services for children with food allergies and paediatric feeding disorder. Recommended areas for future research include exploring caregiver perspectives and the impact of food allergies and paediatric feeding disorder, and consideration of co-designed studies to inform service improvement initiatives. Full article

Background: Patients with Down syndrome (DS) commonly experience psychological and mental problems. Studying the quality of life (QoL) of children with DS is important because it increases knowledge related to understanding the challenges that this group may face. This study aims to examine the QoL of children with DS from a parental perspective in terms of physical, emotional, social, and school domains, depending on several factors, and identify demographic characteristics of their parents that may affect their QoL. Methods: This online survey study was conducted in Saudi Arabia between November 2024 and March 2025. The inclusion criteria targeted parents of children with confirmed DS diagnoses aged between 8 and 18 years. Results: The findings of this study showed that children with DS aged between 0 and 2 years had significantly lower QoL scores (10.18 ± 3.83) compared to other age groups (p = 0.02). In addition, gender differences were significant in the emotional (p = 0.03), social (p = 0.01), and school (p = 0.01) domains, with females scoring lower QoL scores in all areas compared to males. Moreover, educational level showed significant results across all domains, particularly for children with no education, who had the lowest QoL scores in the physical domain (22.34 ± 7.53, p = 0.004), emotional domain (10.41 ± 3.79, p = 0.003), social domain (11.22 ± 4.06, p = 0.001), and school domain (8.75 ± 5.09, p = 0.001). The findings of this study showed that children with DS who are in primary school (odds ratio (OR) = 5.90, 95% confidence interval (CI): 1.85–18.78, p = 0.003) and middle school (OR = 5.27, 95% CI: 1.44–19.31, p = 0.012) had significantly higher odds of better QoL compared to children with no formal education. Additionally, children cared for by their fathers had significantly lower odds compared to those cared for by their mothers (OR = 0.07, 95% CI: 0.01–0.90, p = 0.041). None of the demographic characteristics of caregivers reached a statistical significance level to have influence on caregivers QoL (p > 0.05). Conclusions: The findings of this study demonstrated a low level of QoL, affecting the emotional, social, and school domains, especially among female children with DS aged between 0 and 2 years with no formal education and cared for by their fathers. Governments should develop a comprehensive plan to care for these children and families in order to enhance their rights and quality of life, thereby placing emphasis on those who exhibit parameters related to a lower QoL. Full article

Background: Dementia is a syndrome with a high global prevalence that includes a number of progressive diseases of the brain affecting various cognitive domains such as memory and thinking and the performance of daily activities. It manifests as symptoms which often include significant mood and behaviour changes that are highly varied. Changed moods and behaviours due to dementia may reflect distress and may be stressful for both the person living with dementia and their informal and formal carers. To provide dementia care support specific to mood and behaviour changes, the Behaviours in Dementia Toolkit website (BiDT) was developed using human-centred design principles. The BiDT houses a user-friendly, digital library of over 300 free, practical, and evidence-informed resources to help all care partners better understand and compassionately respond to behaviours in dementia so they can support people with dementia to live well. Objective: (1) To characterize the users that visited the BiDT; and (2) to understand the platform’s early impact on these users. Methods: A multi-method, descriptive study was conducted in the early post-website launch period. Outcomes and measures examined included the following: (1) reach: unique visitors, region, unique visits, return visits, bounce rate; (2) engagement: engaged users, engaged sessions, session duration, pages viewed, engagement rate per webpage, search terms, resources accessed; (3) knowledge change; (4) behaviour change; and (5) website impact: relevance, feasibility, intention to use, improving access and use of dementia guidance, recommend to others. Data was collected using Google Analytics and an electronic survey of website users. Results: From 4 February to 31 March 2024, there were 76,890 unique visitors to the BiDT from 109 countries. Of 76,890 unique visitors to the BiDT during this period, 16,626 were engaged users as defined by Google Analytics (22%) from 80 countries. The highest number of unique engaged users were from Canada (n = 8124) with an engagement rate of 38%. From 5 March 2024 to 31 March 2024, 100 electronic surveys were completed by website users and included in the analysis. Website users indicated that the BiDT validated or increased their dementia care knowledge, beliefs, and activities (82%) and they reported that the website validated their current care approaches or increased their ability to provide care (78%). Further, 77% of respondents indicated that they intend to continue using the BiDT and 81.6% said that they would recommend it to others to review and adopt. Conclusions: The BiDT is a promising tool for sharing practical and evidence-informed information resources to support people experiencing dementia-related mood and behaviour changes. Early evaluation of the website has demonstrated significant reach and engagement with users in Canada and internationally. Survey data also demonstrated high ratings of website relevance, feasibility, intention to use, knowledge change, practice support, and its contribution to dementia guidance. Full article

There has been scant research on the experiences of families caring for adults with intellectual disability who use challenging behaviour as a way of making their needs known. The aim of this scoping review was to synthesize the qualitative research data on the family support experiences of adult family members with intellectual disability who use challenging behaviour in this way. A systematic search was undertaken from five databases during December 2024 and updated in April 2025. A total of 20 studies were included in the review. Data were analysed using a thematic analysis method. The number of study participants in these studies ranged from 4 to 30. Most of them were parents and predominantly mothers. The results show that caring for adults with intellectual disability and challenging behaviour reflects a dual reality. The negative experiences refer to caregiving difficulties and inadequate formal support, while the positive experiences are associated with support from informal sources and caregivers’ fulfilment and gains. The available research did not offer sufficient data for a synthesis of how families might be affected by challenging behaviour. Future research should investigate how the negative and positive aspects of their families can be shaped to make a positive impact on caring for people with intellectual disability and co-existing challenging behaviour. Full article

In Canada, 67% of unpaid caregivers are simultaneously balancing paid employment with unpaid care, equating to over 5.2 million Canadian Carer-Employees (CEs). This balancing act often incurs negative impacts on CEs’ health and well-being, including burnout, resulting in adverse effects on their labour force participation. To mitigate these social and economic impacts, McMaster University partnered with the Canadian Standards Association (CSA) to develop the CSA B701:17 (R2021) Carer-inclusive and accommodating organizations standard and accompanying handbook B701-18HB Helping worker-carers in your organization. Since publication in 2017, there has been minimal uptake of the Standard across Canadian workplaces, with just 1062 complimentary downloads total. To determine the level of uptake across workplaces in Canada, the present mixed-methods study used purposive sampling to collect survey (n = 71) and semi-structured interview data (n = 11). The survey data was analyzed for descriptive statistics and logistic regression modelling. The interview data were thematically analyzed for common CFWPs and barriers to Standard uptake. It was found that only 24% of workplaces have implemented the Standard into their workplace practices, with full implementation and current supports as strong predictors of formal uptake. Prominent themes around barriers to uptake and existing organizational policies highlight the critical importance of workplace culture in facilitating CFWPs. Full article

Nutritional health is essential for older people with dementia. Their feeding is a challenge for which caregivers are not always ready, and an intervention that supports them may have a significant social impact. The aim of this project is to design and evaluate the impact of systematic nursing intervention with formal caregivers to promote nutritional health for older people with dementia. This is a “Nursing Methodology Research” study conducted with formal caregivers of older people with dementia in four Colombian nursing homes. It includes three consecutive phases: (1) systematic intervention design under Whittemore and Grey’s parameters, (2) intervention validation with seven international experts, and (3) measurement of intervention impact, which included a quasi-experimental pre-test–post-test design. The “Nurturing Neurons—Formal Caregivers” intervention met the criteria of systematic health interventions. In response to the work and personal requirements of formal caregivers, the intervention used a tele-support modality. Its content validity ratio (CVR) ranged from 0.88 to 0.92; its content validity index (CVI) was 0.90. The experience was positive for the participant caregivers (94.9%) and professional providers (92.5%). The overall caregivers’ caring competence changed from the medium, 78.1, to the high category, 91.5 (p < 0.001). Their perceived burden of care changed from 70.4 to 63.6 (p < 0.001). In conclusion, “Nurturing Neurons—Formal Caregivers” achieved a positive impact, with changes in the structure, processes, and outputs to promote the nutritional health of older people with dementia. It led to a significant improvement in formal caregivers’ caring competence and decreased their perceived care burden. Its cost–benefit was favorable; it generated health equity for a vulnerable population and achieved unexpected benefits in the context. Full article

Background: Polypharmacy, commonly defined as the use of five or more medications, is a growing concern in hospitals due to its association with adverse drug reactions, functional decline, and increased healthcare costs. Proactive deprescribing, which involves the planned discontinuation of unnecessary or potentially harmful medications, can optimise medication use. However, multiple barriers hinder its implementation. Saudi Arabia offers a unique context for deprescribing due to strong family roles in care, prevalent prescribing norms, and ongoing shifts toward value-based healthcare. This study explores the barriers and facilitators to proactive deprescribing among physicians in Saudi hospitals using the Theoretical Domains Framework (TDF). The TDF was used as it effectively identifies behavioural factors influencing clinical decision making in practice. Methods: Semi-structured interviews were conducted with 27 purposively sampled physicians experienced in managing polypharmacy. The interviews were transcribed and analysed thematically, with behavioural determinants identified and categorised according to the 14 domains of the Theory of Planned Behaviour (TDF). Results: Enablers included the availability of deprescribing guidelines, decision–support tools, interprofessional collaboration, and institutional backing. Physicians with specialised training expressed greater confidence in conducting deprescribing. Identified barriers included limited time, heavy workload, absence of standardised protocols, medico-legal concerns, resistance from patients and caregivers, and lack of formal training. These factors were categorised under seven key TDF domains, with Environmental Context and Resources, Social Influences, and Beliefs About Capabilities identified as the most influential in shaping physicians’ deprescribing practices. Interactions between factors were observed, where supportive environments and collaborative teams helped offset key barriers such as time constraints, legal concerns, and patient resistance. Conclusions: This study identified key behavioural and contextual factors influencing proactive deprescribing in Saudi hospital settings. Addressing barriers such as heavy workload, medico-legal concerns, and lack of standardised protocols through targeted interventions, including clinician training, institutional support, and multidisciplinary collaboration, may facilitate the integration of deprescribing into routine practice. The findings offer context-specific insights to inform future efforts aimed at improving medication safety and optimising prescribing in the Saudi healthcare system. Full article

With the growing trend of population mobility and the aging process in China, a significant number of accompanying elderly migrants have moved to major cities. However, in community public spaces, the behavioral differences between caregiver-oriented elderly migrants (CO-AEMs), family reunion-motivated elderly migrants (FR-AEMs), and local elderly residents hinder social interactions between these groups. This study aims to explore opportunities for cross-group social interaction within the community environment. By utilizing GPS data collection and activity log analysis, along with spatiotemporal behavioral research methods, this study reconstructs the spatiotemporal trajectories of three groups of elderly individuals. The study proposes a social interaction potential (SIP) model based on the “support-constraint” framework. Through qualitative analysis of spatiotemporal behavioral characteristics and quantitative measurement of the degree of spatiotemporal behavioral co-occurrence across four modes, this study reveals the differentiated impact mechanisms of spatial and behavioral factors on social interactions, ultimately assessing SIP in differentiated community spaces and activities. This research highlights differences across spatial, behavioral, and temporal dimensions that hinder social interactions between the groups. Spatial and behavioral differences are primarily attributable to the lifestyle habits and activity preferences of the elderly, while temporal discrepancies reflect varying degrees of family-related constraints across the different groups. Furthermore, informal community public spaces show higher SIP than formal facilities. Additionally, the similarity in behaviors across groups facilitates social interactions. FR-AEMs and local elderly residents show higher SIP in self-care behaviors, while CO-AEMs and local elderly residents demonstrate stronger SIP in behaviors related to their family and grandchildren. Based on the segmented assimilation theory, this study proposes hierarchical community governance and spatial optimization strategies for activities and spaces with different SIP. The aim is to cultivate opportunities for interaction while respecting the characteristics of accompanying elderly migrants and to foster the construction of an inclusive community environment. The findings provide theoretical support and practical pathways for community space planning and social governance in the context of an aging society. Full article

Background: The MULTIPLAT_AGE is a network project which developed a digital platform based on the Comprehensive Geriatric Assessment (CGA) for collecting data and identifying personalized healthcare programs for older people at home. In this article, the final recommendations of the MULTIPLAT_AGE Working Group are reported. Methods: The MULTIPLAT_AGE project included five independent studies developed and carried out by five research centers according to two common principles previously shared by the researchers: (i) the multidimensional approach to older people through the CGA-based Multidimensional Prognostic Index (MPI); (ii) the use of a common web-based platform for collecting data to facilitate healthcare interventions of older people at their home according to the aging in place approach. At the end of the studies, a series of recommendations have been proposed by an expert panel including the principal investigators and discussed by all researchers involved in the MULTIPLAT_AGE project in formal meetings. After discussion, the recommendations have been approved with formal vote by all the researchers during the final meeting of the MULTIPLAT_AGE project. Results: The recommendations are addressed to healthcare providers, policy decision-makers, caregivers, and patients. In summary, the CGA-based interventions and technologies adopted in the MULTIPLAT_AGE project reduced length of hospital stay, improved multidimensional frailty, walking safety, physical and cognitive performances, and reduced fear of falling in older people across different clinical settings and suffering from different diseases. Conclusions: The final recommendations of the MULTIPLAT_AGE Working Group could be a useful instrument to facilitate the use of technologies along with CGA-based interventions to improve the management of older people at home. Full article

This study aimed to examine caregivers’ perceptions, practices, and challenges regarding rehabilitation services for people with disabilities, with a focus on identifying factors influencing their decisions to bring care recipients for formal rehabilitation. A cross-sectional study was conducted in rural Thai Nguyen Province, Vietnam. Data were collected from 214 primary caregivers using a structured questionnaire covering demographics, caregiving roles, and rehabilitation-related perceptions. A pilot study was conducted to refine the tool, and data were collected via face-to-face interviews by a trained team. Statistical analyses included descriptive statistics, chi-square tests, and stepwise logistic regression to identify key predictors of care-seeking behaviors. Results showed that 92% of caregivers perceived rehabilitation as necessary or very necessary. Female caregivers were more likely to provide care at home (95.3%), while male caregivers were more likely to utilize hospital-based services (73.5%) and to bring care recipients for rehabilitation overall (79.4% vs. 67.1%). Logistic regression revealed that female caregivers were significantly less likely than males to bring people with disabilities in for care (OR = 0.34, p = 0.02). Longer caregiving duration was associated with a reduced likelihood of seeking care (OR = 0.96 per year, p < 0.001), whereas caregivers of individuals with mobility needs (OR = 3.15, p < 0.001) and social integration needs (OR = 2.12, p = 0.05) were significantly more likely to seek care. These findings highlight gender-based differences and caregiving dynamics that influence access to rehabilitation. To enhance rehabilitation outcomes and support caregiver engagement, targeted policies are needed to address gender roles, caregiving fatigue, and the specific needs of care recipients. Full article