Limits...
Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach.

Dawson A, Bowes A, Kelly F, Velzke K, Ward R - BMC Geriatr (2015)

Bottom Line: The review was commissioned to support an inspection regime and identifies the current state of scientific knowledge regarding appropriate and effective services in relation to a set of key outcomes derived from Scottish policy, inspection practice and standards.However, emphases on care at home and reduction in the use of institutional long term care are common to many international policy contexts and welfare regimes.Evaluations identified weaknesses in many published accounts of research, including lack of methodological detail and failure to evidence conclusions.

View Article: PubMed Central - PubMed

Affiliation: School of Applied Social Science, University of Stirling, Stirling, FK9 4LA, UK. a.s.f.dawson@stir.ac.uk.

ABSTRACT

Background: This paper synthesises research evidence about the effectiveness of services intended to support and sustain people with dementia to live at home, including supporting carers. The review was commissioned to support an inspection regime and identifies the current state of scientific knowledge regarding appropriate and effective services in relation to a set of key outcomes derived from Scottish policy, inspection practice and standards. However, emphases on care at home and reduction in the use of institutional long term care are common to many international policy contexts and welfare regimes.

Methods: Systematic searches of relevant electronic bibliographic databases crossing medical, psychological and social scientific literatures (CINAHL, IngentaConnect, Medline, ProQuest, PsychINFO and Web of Science) in November 2012 were followed by structured review and full-text evaluation processes, the latter using methodology-appropriate quality assessment criteria drawing on established protocols.

Results: Of 131 publications evaluated, 56 were assessed to be of 'high' quality, 62 of 'medium' quality and 13 of 'low' quality. Evaluations identified weaknesses in many published accounts of research, including lack of methodological detail and failure to evidence conclusions. Thematic analysis revealed multiple gaps in the evidence base, including in relation to take-up and use of self-directed support by people with dementia, use of rapid response teams and other multidisciplinary approaches, use of technology to support community-dwelling people with dementia, and support for people without access to unpaid or informal support.

Conclusions: In many areas, policy and practice developments are proceeding on a limited evidence base. Key issues affecting substantial numbers of existing studies include: poorly designed and overly narrowly focused studies; variability and uncertainty in outcome measurement; lack of focus on the perspectives of people with dementia and supporters; and failure to understanding the complexities of living with dementia, and of the kinds of multifactorial interventions needed to provide holistic and effective support. Weaknesses in the evidence base present challenges both to practitioners looking for guidance on how best to design and deliver evidence-based services to support people living with dementia in the community and their carers and to those charged with the inspection of services.

No MeSH data available.


Related in: MedlinePlus

PRISMA diagram of the review process. This has been uploaded as a separate file.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4465454&req=5

Fig1: PRISMA diagram of the review process. This has been uploaded as a separate file.

Mentions: The first step was a systematic search of relevant bibliographic databases to ensure the necessary broad coverage of areas of interest, crossing medical, psychological and social scientific literatures. We searched CINAHL, IngentaConnect, Medline, ProQuest, PsychINFO and Web of Science electronic databases. The searches took place in November 2012 and were restricted to English language sources, including international literature, published in 2002 or later. The intention of the searches was to identify, quantify and summarise the evidence base around those areas of interest to the commissioning body outlined above. Many of the topics of interest referred to recent innovations in service, and we expected that literature covering longer standing aspects of service provision would refer back to earlier work if relevant. The search terms were developed in collaboration with the commissioning body and informed by a set of key outcomes for people with dementia and their carers provided by them as described above and detailed in Table 1. The search terms used for the review are listed below. Figure 1 provides a PRISMA diagram of the review process.Figure 1


Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach.

Dawson A, Bowes A, Kelly F, Velzke K, Ward R - BMC Geriatr (2015)

PRISMA diagram of the review process. This has been uploaded as a separate file.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4465454&req=5

Fig1: PRISMA diagram of the review process. This has been uploaded as a separate file.
Mentions: The first step was a systematic search of relevant bibliographic databases to ensure the necessary broad coverage of areas of interest, crossing medical, psychological and social scientific literatures. We searched CINAHL, IngentaConnect, Medline, ProQuest, PsychINFO and Web of Science electronic databases. The searches took place in November 2012 and were restricted to English language sources, including international literature, published in 2002 or later. The intention of the searches was to identify, quantify and summarise the evidence base around those areas of interest to the commissioning body outlined above. Many of the topics of interest referred to recent innovations in service, and we expected that literature covering longer standing aspects of service provision would refer back to earlier work if relevant. The search terms were developed in collaboration with the commissioning body and informed by a set of key outcomes for people with dementia and their carers provided by them as described above and detailed in Table 1. The search terms used for the review are listed below. Figure 1 provides a PRISMA diagram of the review process.Figure 1

Bottom Line: The review was commissioned to support an inspection regime and identifies the current state of scientific knowledge regarding appropriate and effective services in relation to a set of key outcomes derived from Scottish policy, inspection practice and standards.However, emphases on care at home and reduction in the use of institutional long term care are common to many international policy contexts and welfare regimes.Evaluations identified weaknesses in many published accounts of research, including lack of methodological detail and failure to evidence conclusions.

View Article: PubMed Central - PubMed

Affiliation: School of Applied Social Science, University of Stirling, Stirling, FK9 4LA, UK. a.s.f.dawson@stir.ac.uk.

ABSTRACT

Background: This paper synthesises research evidence about the effectiveness of services intended to support and sustain people with dementia to live at home, including supporting carers. The review was commissioned to support an inspection regime and identifies the current state of scientific knowledge regarding appropriate and effective services in relation to a set of key outcomes derived from Scottish policy, inspection practice and standards. However, emphases on care at home and reduction in the use of institutional long term care are common to many international policy contexts and welfare regimes.

Methods: Systematic searches of relevant electronic bibliographic databases crossing medical, psychological and social scientific literatures (CINAHL, IngentaConnect, Medline, ProQuest, PsychINFO and Web of Science) in November 2012 were followed by structured review and full-text evaluation processes, the latter using methodology-appropriate quality assessment criteria drawing on established protocols.

Results: Of 131 publications evaluated, 56 were assessed to be of 'high' quality, 62 of 'medium' quality and 13 of 'low' quality. Evaluations identified weaknesses in many published accounts of research, including lack of methodological detail and failure to evidence conclusions. Thematic analysis revealed multiple gaps in the evidence base, including in relation to take-up and use of self-directed support by people with dementia, use of rapid response teams and other multidisciplinary approaches, use of technology to support community-dwelling people with dementia, and support for people without access to unpaid or informal support.

Conclusions: In many areas, policy and practice developments are proceeding on a limited evidence base. Key issues affecting substantial numbers of existing studies include: poorly designed and overly narrowly focused studies; variability and uncertainty in outcome measurement; lack of focus on the perspectives of people with dementia and supporters; and failure to understanding the complexities of living with dementia, and of the kinds of multifactorial interventions needed to provide holistic and effective support. Weaknesses in the evidence base present challenges both to practitioners looking for guidance on how best to design and deliver evidence-based services to support people living with dementia in the community and their carers and to those charged with the inspection of services.

No MeSH data available.


Related in: MedlinePlus