PubMed · 10117856
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
Ethics and complex discharges.. https://pubmed.ncbi.nlm.nih.gov/10117856/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
BackgroundDementia with Lewy bodies (DLB) is a common degenerative dementia, but no studies investigate bereaved caregiver experiences.ObjectiveTo investigate the experiences of caregivers three months after the death of persons with DLB using a mixed-methods approach.MethodsDyads of individuals with moderate-advanced DLB and their primary informal caregivers were followed prospectively every 6 months until the person with DLB died. Caregivers completed a study visit with questionnaires and a semi-structured interview ∼3 months later. Spearman correlation coefficients and Wilcoxon rank-sum tests evaluated the relationships of post-death measures with pre-death patient and caregiver variables. Thematic analysis was used to analyze the interviews.ResultsSeventy-three caregivers completed visits (mean 3.5 months post-death). Most of the caregivers were women (82.2%) and spouses (76.7%) or adult children (17.8%). Over 40% had scores indicating risk for clinical depression. Post-death caregiver experiences (depression, quality of life, grief, resilience) correlated with pre-death caregiver experiences. Post-death experiences did not associate with patient characteristics, disease-related symptoms, or healthcare services used in the last 6 months of life. Trajectories for caregiver measures from pre- to post-death visits varied widely. Interview themes included grief and sadness, anger, guilt and regret, relief, appreciation/gratitude, and adjusting to a new normal.ConclusionsThe finding that pre-death caregiving experiences have the strongest association with post-death experiences emphasizes the critical importance of accessible and evidence-based caregiver support before and after the death of a person with DLB. Research is needed to develop interventions for current and bereaved caregivers of individuals with DLB.Trial registration informationNCT04829656 (submitted 2021-03-22).
OBJECTIVE: To determine the effect of parental reported difficulty getting care without long waits from a primary care provider (PCP) on nonurgent pediatric emergency department (ED) use. DESIGN: Case-control study. SETTING: Pediatric ED within an urban pediatric hospital. PARTICIPANTS: Children, aged 6 months to 12 years, who presented with a chief complaint from a predetermined list of nonurgent (cases) or emergent complaints (controls). MAIN OUTCOME MEASURES: Caregivers assessed interactions with a PCP during the previous 12 months by completion of a Consumer Assessment of Health Plans (CAHPS) survey. Baseline demographic variables were compared. Composite CAHPS scores assessing difficulty meeting medical needs, including getting care without long waits, were compared using median tests. Multivariate logistic regression was used to assess the effect of getting care without long waits on nonurgent ED use. RESULTS: Of 821 caregivers approached, 719 (87.6%) completed the survey, including 366 cases (50.9%) and 353 controls (49.1%). Those with emergent complaints were older, healthier, and more likely to be male; had higher caregiver education and income levels; and were more likely to have a PCP. Analysis of the CAHPS composite scores revealed increased difficulty meeting medical needs for those with nonurgent complaints, with the greatest difference noted for getting care without long waits (median score, 3.25 vs 3.67; P<.001). In multivariate regression, increased ability to get care without long waits was associated with decreased odds of nonurgent ED use (odds ratio, 0.48; 95% confidence interval, 0.32-0.72). CONCLUSION: Parental-reported previous difficulty getting care without long waits from a PCP is a risk factor for nonurgent ED use.
OBJECTIVES: To identify ages at which gross motor developmental milestones and fine motor skills required for self-feeding were reported by primary caregivers and to relate these self-feeding skills to energy and nutrient intakes. DESIGN: Cross-sectional survey of households with infants/toddlers, ages 4 to 24 months. SUBJECTS/SETTING: Telephone survey using a national random sample of infants and toddlers (n=3,022). METHODS: Primary caregivers reported their children's food intake (one 24-hour recall), the ages when caregivers reported self-feeding skills were shown, and the number of teeth. STATISTICAL ANALYSES PERFORMED: Children's reported ages for gross motor developmental milestones, self-feeding skills, and the number of erupted teeth were summarized. Using t tests, differences in energy and nutrient intake were determined by age groupings and by the absence or presence of each self-feeding skill. RESULTS: Self-feeding skills achieved in the first 2 years and details about age ranges at which developmental readiness to self-feed were evidenced are described. The ages at which children were reported to show gross motor developmental milestones and eruption of teeth occurred within expected age ranges. A majority of the children who were reported to show developmental readiness to self-feed at an earlier age (7 to 14 months) had higher intakes of energy and most nutrients than those who did not. By 15 to 18 months, most of the children were reported to show comparable self-feeding skills regardless of whether they self-fed earlier or later. APPLICATIONS/CONCLUSIONS: Assuming a variety of nutritious foods are offered to infants and toddlers, caregivers may encourage self-feeding without concern for jeopardizing energy and nutrient adequacy. In the first year, the addition of foods that require chewing should reflect the number of erupted teeth.