Nurse-led family-based approach in primary health care for patients with type 2 diabetes mellitus: a qualitative study.

PURPOSE: The prevalence of Type 2 diabetes is rapidly increasing, with 537 million people estimated to have diabetes in 2021. The literature suggests that nurses can deliver effective person-centred diabetes care and that families can be essential in supporting patients. Thus, a Nurse-led Family-based (NLFB) approach may be particularly effective. This study aims to explore the perceptions of nurses, adults with type 2 diabetes, and family members regarding the NLFB intervention. METHODS: Guided by the UK Medical Research Council Framework, this seminal study adopted a qualitative, descriptive approach with content analysis. Data were obtained through 16 semi-structured, in-depth interviews. Themes emerged based on an inductive process using constant comparison (Graneheim and Lundman 2004). The COREQ checklist was used in ensuring rigour. RESULTS: Three main themes emerged includes: (1) nurses' experiences with current diabetes care practices, (2) stakeholders' views on the development of a NLFB approach, and (3) merging the nurse-led family aspects into the diabetes care. The key challenges are the dominant medical model, lack of specialist nurses, and time. The key facilitators are knowledge and social support. CONCLUSION: The study recommends stakeholders embrace nursing empowerment strategies and involve families to enhance the nurses' advanced roles and family inclusion in healthcare.

Dementia research in Ireland: What should we prioritise?

Background: Dementia research prioritisation allows for the systematic allocation of investment in dementia research by governments, funding agencies and the private sector. There is currently a lack of information available in Ireland regarding priority areas for dementia research. To address this gap, a dementia research prioritisation exercise was undertaken, consisting of an online survey of professionals in the dementia field and workshops for people living with dementia and family carers. Methods: (1) An anonymous online survey of professionals, based on an existing WHO global survey: the global survey was adapted to an Irish context and participants were asked to score 65 thematic research avenues under five criteria; (2) A mixed-methods exercise for people living with dementia and family carers: this involved two facilitated workshops where participants voted on the research themes they felt were important to them and should be addressed through research. Results: Eight of the top ten research priorities in the survey of professionals ( n=108) were focused on the delivery and quality of care and services for people with dementia and carers. Other research avenues ranked in the top ten focused on themes of timely and accurate diagnosis of dementia in primary health-care practices and diversifying therapeutic approaches in clinical trials. Participants in the workshops ( n=13) ranked 'better drugs and treatment for people with dementia', 'dementia prevention/ risk reduction' and 'care for people with dementia and carers' as their top priority areas. Conclusions: Findings from this prioritisation exercise will inform and motivate policymakers, funders and researchers to support and conduct dementia-focused research and ensure that the limited resources made available are spent on research that has the most impact for those who will benefit from and use the results of research.

Socio-ecological determinants of older people's mental health and well-being during COVID-19: A qualitative analysis within the Irish context.

Background: Evidence indicates that older people with biological and social vulnerabilities are at high risk of short- and long-term consequences related to the COVID-19 pandemic. However, studies have also highlighted that the crisis may present opportunities for personal growth if older individuals are met with appropriate resources and support. Objective: The aim of this study was to explore the perceptions of older people regarding how individual, social, and environmental factors have supported or hindered their well-being and health during COVID-19. Methods: We analyzed data collected between April-May and October-November 2021 from the Well-being, Interventions and Support during Epidemics (WISE) study, a qualitative investigation of community-dwellers based in Ireland and aged 65 years or over. Participants (n = 57) completed written submissions, narrative interviews and/or go-along interviews detailing their experiences during the pandemic. Framework analysis was carried out in NVivo 12 to identify determinants, linkages, and explanations within Bronfenbrenner's socio-ecological model. Results: The mean age of participants was 74.9 years, 53% were female, 45% lived alone, and 86% lived in areas with high urban influence. Our findings highlight the heterogeneous effect of COVID-19 across diverse older individuals who held distinct concerns, capabilities, and roles in society before and during the pandemic. Multi-scalar contextual characteristics such as individual's living arrangements, neighborhood social and built environments, as well as social expectations about aging and help seeking, had an influential role in participants' well-being and available supports. We identified mixed views regarding public health restrictions, but a consensus emerged questioning the suitability of one-size-fits-all approaches based on chronological age. Conclusions: Our results suggest that some negative pandemic consequences could have been avoided by increasing collaboration with older people and with the provision of clearer communications. The interdependencies identified between individual characteristics and socio-ecological factors that influenced participants' availability of supports and development of adaptive strategies represent areas of opportunity for the development of age-friendly interventions during and beyond public health crises.

Freedom and loneliness: dementia caregiver experiences of the nursing home transition.

BACKGROUND: the transition to nursing home care has previously been linked to negative outcomes for spousal caregivers of persons with dementia (PwD). However, little is known about the experience or trajectory of loneliness in spousal caregivers during this time. OBJECTIVES: to explore experiences of loneliness in caregivers during the nursing home admission of their spouse or partner with dementia. METHODS: semi-structured interviews were conducted with 11 individuals living in Ireland between Oct 2020 and June 2021, who were married to/partnered with a PwD who had, in the past 7 years, moved to full-time nursing home care. Data were collected and analysed using a deductive qualitative analytic strategy in the grounded theory tradition. RESULTS: data were interpreted in the context of Weiss' typology of social and emotional loneliness and indicated that social loneliness increased for many at the point of diagnosis, decreasing somewhat after the transition, while emotional loneliness increased across the transition. Data were used to refine an existing synthesised model of loneliness, providing an updated model of the causes and contexts of loneliness. CONCLUSIONS: the transition to nursing home care differentially affects loneliness subtypes. Results have implications for other transitions, which should be assessed in terms of various subtypes of loneliness. Our refined theoretical synthesis model of loneliness also warrants further evaluation.

Effective maNagement of depression among patients witH cANCEr (ENHANCE): a protocol for a hybrid systematic review and network meta-analysis of randomised controlled trials of interventions for depressive symptoms.

BACKGROUND: Depression is common among patients with cancer and is associated with lower treatment participation, lower satisfaction with care, poorer quality of life, greater symptom burden and higher healthcare costs. Various types of interventions (e.g. pharmacological, psychotherapy) are used for the treatment of depression. However, evidence for these among patients with cancer is limited. Furthermore, the relative effectiveness and acceptability of different approaches are unknown because a direct comparison between all available treatments has not been carried out. We will address this by conducting a network meta-analysis (NMA) of interventions for depression among people with cancer using a hybrid overview of reviews and systematic review methodology. METHODS: We will search for and extract data from systematic reviews of randomised controlled trials (RCTs) of depression interventions for patients with cancer from inception, before performing a supplemental search for more recent RCTs. We will include RCTs comparing pharmacological, psychotherapy, exercise, combination therapy, collaborative care or complementary and alternative medicine interventions with pill placebo, no treatment, waitlist, treatment as usual or minimal treatment control groups, or directly in head-to-head trials, among adults who currently have cancer or have a history of any cancer and elevated depressive symptoms (scores above a cut-off on validated scales or meeting diagnostic criteria). Our primary outcomes will be change in depressive symptoms (standardised mean difference) and intervention acceptability (% who withdrew). Our secondary outcomes will be 6-month change in depressive symptoms, health-related quality of life, adverse events and mortality. We will independently screen for eligibility, extract data and assess risk of bias using the RoB 2 tool. We will use frequentist random-effects multivariate NMA in Stata, rankograms and surface under the cumulative ranking curves to synthesise evidence and obtain a ranking of intervention groups. We will explore heterogeneity and inconsistency using local and global measures and evaluate the credibility of results using the Confidence in NEtwork Meta-Analysis (CINeMA) framework. DISCUSSION: Our findings will provide the best available evidence for managing depression among patients with cancer. Such information will help to inform clinical guidelines, evidence-based treatment decisions and future research by identifying gaps in the current literature. SYSTEMATIC REVIEW REGISTRATION: Submitted to PROSPERO (record number: 290145), awaiting registration.

A scoping review protocol of age-friendly practices during the COVID-19 pandemic.

Background: Actions focused on age-friendly environments contribute to promote and maintain older people's functional ability and may enable them to contribute to their communities and enjoy life. As such, age-friendly practices require collaboration between diverse stakeholders across multiple sectors responsible for natural, built, and social environments, which can be particularly relevant during public health emergencies when socio-ecological vulnerabilities become more salient and may disproportionally affect older people. This paper presents a protocol for a scoping review aiming to investigate the breadth of evidence concerning the development, implementation, and evaluation of age-friendly practices during the COVID-19 pandemic. The protocol sets out the objectives, methods, and dissemination plans for the review. Methods: The scoping review will be conducted in line with the Joanna Briggs Institute (JBI) scoping review methodology. We will search databases (PubMed, Web of Science, Embase, CINAHL, Scopus, PsychNet) and grey literature sources. Publications relating to practices across the 8 domains of the World Health Organization's age-friendly cities and communities' framework will be included. A tabular data extraction tool will be used to facilitate a narrative synthesis of results. Ethics and dissemination: Ethical approval is not required as the methods proposed for this scoping review consist of collecting publicly available data. Findings will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) and submitted to a journal for academic dissemination. Lay dissemination plans include an infographic and a blog-style article presenting our core results. Conclusion: The publication of this protocol allows for transparency in the systematic process of a scoping review focused on age-friendly practices during COVID-19. Findings emerging from the scoping review will provide insights into the evidence available regarding age-friendly activities during COVID-19 and may inform future age-friendly practices during public health emergencies and beyond.

Well-being, Interventions and Support during Epidemics (WISE): Protocol for a qualitative longitudinal study of older adults' experiences during COVID-19.

Background: The coronavirus disease 2019 (COVID-19) pandemic has the potential to trigger multiple stress domains and lead to long-term repercussions in an individual's quality of life, health, and well-being. Stressors from the pandemic are likely to be experienced in many ways by older adults with heterogeneous life experiences and supports available. In this context, it is necessary to tease out the underlying mechanisms leading to positive and negative well-being and mental health across interdependent individual, social and environmental factors. The aim of the present study is to explore community-dwelling older adults' experiences during the COVID-19 pandemic, with a particular focus on mental health and psychosocial well-being. Methods: An exploratory longitudinal qualitative study will be conducted with data collected through written submissions, narrative interviews and go-along interviews with older adults living in Irish community settings. To enable the exploration of participants' responses to the evolving social, economic and environmental circumstances, data collection will take during the implementation of public health restrictions and once these are eased and the vaccination program is rolled out. Framework analysis will be carried out to identify data themes, linkages, and explanations within Bronfenbrenner's socio-ecological model. Ethics and dissemination:  Ethical approval has been granted by the Royal College of Surgeons in Ireland, Research Ethics Committee (REC202011028). Findings will be disseminated through peer-reviewed journal publications, presentations at relevant conferences, and in consultation with Public and Patient Involvement (PPI) contributors. A lay summary of findings and infographic will be distributed to multiple stakeholders including our PPI panel, older people, caregivers, community organizations, charities, and media.

Factors influencing the cost of care and admission to long-term care for people with dementia in Ireland.

OBJECTIVE: To explore the factors associated with the cost of care and admission to long-term care (LTC) for people with dementia living at home in Ireland. METHODS: Data on formal and informal resource use for people with dementia, and their LTC admission, were obtained from a national study of spousal dementia caregivers. Functional status was measured using the Bristol Activities of Daily Living Scale, while behavioural and psychiatric symptoms were evaluated using the Neuropsychiatric Inventory. Multivariable regression analysis was used to model costs and the predictors of LTC admission. RESULTS: Physical and cognitive symptoms were significantly associated with costs. Severely impaired functional ability was associated with a €2,308 increase in mean total 30-day monthly costs. Psychosis was associated with a €335 increase in primary and community 30-day monthly care costs. These factors also make it more likely that a person with dementia is admitted to LTC. Having an older caregiver also increases the risk of admission to LTC, while living in a rural area and having a female caregiver reduce the likelihood of admission. CONCLUSIONS: Dependency matters for the cost of care. Physical and cognitive symptoms, caregiver age and gender, and geographic location are significant predictors of admission to LTC.

Caregiver Choice and Caregiver Outcomes: A Longitudinal Study of Irish Spousal Dementia Caregivers.

BACKGROUND: The perception of choice in becoming a caregiver may impact on caregiver psychological and physical health. We determined the proportion of spousal dementia caregivers who felt they had a choice, and examined whether lack of choice in taking up the caregiving role and the perceived degree of choice in caregiving predicted caregiver health and wellbeing and care-recipient placement in long-term care at 1-year follow-up. METHODS: We performed secondary analyses of data from DeStress, a longitudinal study of 251 spousal dementia caregivers in Ireland. We used multivariate logistic and linear regression analyses to examine whether lack of choice (a dichotomous item) and/or the perceived degree of choice (a 9-point scale) at baseline predicted caregiver health (number of chronic health conditions; self-reported health) and wellbeing (e.g., burden, anxiety, depression, stress, and positive aspects of caregiving) and care status (continued care at home or placement in long-term care) at follow-up. RESULTS: The vast majority of caregivers (82%) reported that they had no choice in taking up the caregiving role. Nevertheless, nearly three-quarters (74%) responded above the midpoint on the rating scale (Mean = 6.82, SD = 3.22; Median = 9; Mode = 9), indicating they provided care voluntarily. Caregivers who reported a greater degree of choice were more likely to still be providing care at home at follow-up and to identify benefits from providing care. Neither choice nor degree of choice predicted any other caregiver outcomes. CONCLUSION: For the vast majority of spousal dementia caregivers, taking up the caregiving role is not perceived as a choice; yet, most report performing this role voluntarily. Thus, facilitating greater choice may not necessarily diminish the key contribution family caregivers make to the care system. Although we found no evidence that caregiver choice predicted more positive caregiver health and wellbeing, the perception of choice is important in and of itself, and may benefit caregivers by facilitating the identification of positive aspects of care and be a factor in delaying care-recipient placement in long-term care. Future research should be especially mindful of how caregiver choice is assessed and how this may affect the resulting prevalence of choice.

Cognitive functioning among cognitively intact dementia caregivers compared to matched self-selected and population controls.

PURPOSE OF THE STUDY: Caregiving for a person with dementia is frequently used to model the impact of chronic stress on health, including cognitive functioning. However, the prevalence of typically healthier, self-selecting non-caregiving control groups could contribute to a picture of poorer caregiver performance and overstate the negative effects of stress. We investigated differences in cognitive performance between dementia caregivers and two groups of non-caregivers recruited using different sampling methods. DESIGN AND METHODS: We compared cognitive function and psychological wellbeing among 252 spousal dementia caregivers with demographically matched non-caregiving control groups drawn from (1) a population study and (2) a self-selecting sample. Comparable cognitive measures included immediate and delayed recall, processing speed reaction time and verbal fluency. RESULTS: Caregiver and non-caregiver performance was comparable on most cognitive domains. However, caregivers outperformed both control groups on processing speed (p ≤ .05) and reaction time (p ≤ .05), despite having higher levels of stress and depression (ps < .001). Furthermore, caregivers had significantly better free recall than self-selecting controls (p < .001). IMPLICATIONS: Our results, overall, do not support the idea that caregiving is associated with stress-induced cognitive deficits. Rather, the trend toward better caregiver performance is consistent with the healthy caregiver hypothesis.

Risk of Cognitive and Functional Impairment in Spouses of People With Dementia: Evidence From the Health and Retirement Study.

Caring for a spouse with dementia is a chronic stressor that may compromise caregivers' own cognitive functioning and capacity to provide adequate care. We examined whether having (i) a spouse with dementia and (ii) a spouse who requires assistance with activities of daily living predicted cognitive and functional impairments in respondents to the Health and Retirement Study (n = 7965). Respondents who had a spouse who requires care had poorer cognitive functioning, whereby this relationship was significantly stronger for male respondents. Having a spouse with dementia moderated the relationship between income and cognition and predicted caregiver functional impairment, though not when depression was controlled. Although we found no significant differences on any individual cognitive domains between 179 dementia caregivers and sociodemographically matched noncaregivers, our findings suggest that caregivers, especially men, and low-income individuals who have a spouse with dementia are more vulnerable to adverse cognitive outcomes. Targeting depression in spouses of people with dementia may help to prevent functional impairments.

Predictors of fatigue in cancer patients before and after chemotherapy.

Fatigue is a debilitating and common condition in cancer patients. This study examined pretreatment predictors of fatigue before chemotherapy and also assessed whether these could prospectively predict fatigue posttreatment. A total of 100 patients completed questionnaires assessing psychological factors, physical activity and sleep. A subsample of 26 participants wore actigraphs to objectively assess sleep/wake and activity/rest. Fatigue was measured pretreatment and posttreatment and at follow-up several months later. Greater pretreatment pain, depression, stress and sleep disruption significantly predicted greater fatigue before chemotherapy, explaining 55 percent of the variance. Pretreatment fatigue significantly predicted post-treatment fatigue. No other significant prospective predictors of posttreatment fatigue emerged.

'I'm not complaining because I'm alive': barriers to the emergence of a discourse of cancer-related fatigue.

OBJECTIVE: Cancer-related fatigue (CRF) is a potentially chronic condition that is inadequately discussed, diagnosed and treated. This study examined the factors that contribute to the absence of a discourse of CRF. METHOD: A thematic discourse analysis was carried out on the 'additional comments' left by 73 fatigued cancer patients and survivors as part of a questionnaire study on CRF. RESULTS: The findings indicated that conflict between patients' own conceptualisations of CRF and those of family/friends and/or medical professionals hampers social and medical dialogue of CRF. Fatigue forms a part of patients' ongoing cancer identity even after cancer treatment has been completed; however, because of the dominance of wider social discourses on recovery from illness and cancer survivorship, others fail to recognise individual narratives of CRF when these deviate from or oppose such established discourses. Furthermore, the development of a discourse of CRF is actively obstructed because the enormity of cancer invalidates and overshadows patients' postcancer experiences. CONCLUSION: 'Additional comments' are a rich source of data that can give insight into issues facing patients. Beyond the lack of recognition, support and interventions available for CRF, broader discourses of health, illness and cancer hamper communication regarding this side effect.

C-reactive protein predicts fatigue independently of depression in breast cancer patients prior to chemotherapy.

Heightened inflammatory activity has been proposed as a mechanism for the development of cancer-related fatigue (CRF), a common and distressing condition that can negatively affect quality of life. Inflammation is also implicated in the pathogenesis of depression, and depression is a strong predictor of CRF. Thus, the role of the pro-inflammatory cytokine network in CRF may be mediated by depression or both conditions may share similar underlying physiological processes. The current study investigated associations between fatigue, depression and inflammatory cytokine (IFN-γ, IL-6, TNF-α) and CRP concentrations, as well as kynurenine pathway (KP) activation, in 61 breast cancer patients prior to chemotherapy. Changes in inflammatory markers and KP activation over time were also explored, and associations with changes in fatigue and depression were examined. Higher levels of CRP were significantly correlated with fatigue and depression before chemotherapy; nevertheless, CRP predicted fatigue independently of depression. Although greater kynurenine concentrations were associated with increased immune activation, there was no evidence that the KP played a role in fatigue or depression. Furthermore, no relationships emerged between either fatigue or depression and IFN-γ, IL-6, or TNF-α before chemotherapy. Nevertheless, kynurenine levels pre- and post-treatment significantly predicted changes in depression, suggesting that heightened KP activation may contribute to depressive symptoms in patients treated for cancer. In addition, IL-6 significantly covaried with fatigue. These preliminary findings provide some support for the idea that low-grade inflammation contributes to the development of CRF, independently of depression; however, there was no evidence that this is mediated by KP activity.

Assessing patients' beliefs about their cancer-related fatigue: validation of an adapted version of the Illness Perception Questionnaire.

Cancer-related fatigue (CRF) is a common and distressing side-effect of cancer treatment. The present study developed a brief version of the Illness Perception Questionnaire (IPQ) for assessing patients' representations of CRF. Cancer patients and survivors (n = 155) completed a revised version of the IPQ as well as measures of fatigue severity at two different time-points. Confirmatory factor analysis at both Time 1 and 2 showed that the seven-factor solution based on the Self-Regulation Model fit the data adequately and factorial invariance over the two time-points was supported. The resulting subscales exhibited good internal consistency and test-retest reliability. The adapted version of the IPQ shows promise for the assessment of patient perceptions regarding CRF. The scale may be able to be used clinically to identify if patients have inaccurate or unhelpful representations of CRF and to help tailor interventions for persistent fatigue in cancer survivors.

Appearance matters: the frame and focus of health messages influences beliefs about skin cancer.

OBJECTIVES: This study sought to ascertain whether the health message 'framing effect', which has been observed for several diseases, occurs for messages concerning the consequences of skin cancer for one's appearance or one's health. Specifically, the effect of the frame and focus of health messages on intentions to perform skin protection behaviours and the perceived threat of skin cancer was investigated. DESIGN: Consistent with previous research and to avoid carry-over effects, a two-factor, between-groups (message frame: gain vs. loss × message focus: appearance vs. health) design was used. METHODS: Participants (N= 390) were recruited using convenience sampling and presented with one of four health messages, which were embedded in a questionnaire concerning beliefs about skin cancer (intentions to perform different skin protection behaviours, the perceived threat of skin cancer) and body consciousness. The health messages were framed in terms of loss (risks of sun exposure) or gain (benefits of skin protection) and focused on the consequences of sun exposure for one's appearance or one's health. The primary outcome measures were responses on rating scales concerning the perceived threat of skin cancer, intentions to perform different skin cancer protection behaviours, and body consciousness. RESULTS: Perceived threat of skin cancer was found to be greater for appearance-focused messages and intentions to perform different skin protection behaviours were greater for loss-framed messages. These findings held when individual differences in body consciousness were controlled for. CONCLUSIONS: These findings suggest that, for the communication of information about skin cancer to be effective, messages must focus on the impact of sun exposure and inadequate skin protection for people's appearance, not just their health. Moreover, to maximize effectiveness, health messages about skin cancer should take account of dispositional differences in the importance placed upon one's appearance.

The relationship between prostate cancer knowledge and beliefs and intentions to attend PSA screening among at-risk men.

OBJECTIVE: To examine the level of knowledge regarding prostate cancer and screening, to investigate prostate cancer illness perceptions, and to test the efficacy of the theory of planned behaviour (TPB) for understanding intentions to attend prostate-specific antigen (PSA) screening, when offered by a doctor or self-initiated. METHODS: Two hundred and twenty three men completed the PROCASE knowledge scale, the Revised Illness Perceptions Questionnaire and a questionnaire developed to assess attitudes, subjective norms and perceived control over intentions to attend for PSA testing. RESULTS: Participants had a high level of knowledge and accurate perceptions of prostate cancer. Controlling for knowledge and experience with prostate cancer, the TPB accounted for 49% (p<0.001) of the variation in intentions to attend if recommended by a doctor. CONCLUSION: The sample of at-risk men were characterised by good knowledge, accurate mental representation of prostate cancer, and positive beliefs towards the PSA test. Components of the TPB accounted for statistically significant amounts of variation in intentions to attend for testing. PRACTICE IMPLICATIONS: Beliefs about prostate cancer do not appear to influence PSA testing intentions; healthcare providers' recommendations may have the strongest influence on decisions to attend for PSA testing.

Neuropsychology of self-awareness in young adults.

Disorders of self-awareness are common following cortical damage, particularly to the frontal lobes, but there have been few studies of individual differences in self-awareness in the normal population. In the current study, we explored patterns of metacognitive awareness among healthy young adults, based on discrepancies of self- and other-ratings on the Frontal Systems Behavior Scale (FrSBe; Grace and Malloy, 2002). Those who showed poor metacognitive awareness showed more frequent lapses of attention, and higher levels of everyday absentmindedness, than those who accurately appraised their own behavior or those who overestimated their own FrSBe scores. Furthermore, among those with poor metacognitive awareness, online emergent awareness correlated positively with prospective memory performance, and negatively with anxiety scores. Our results suggest that accurate self-awareness in non-neurological participants relies on efficient sustained attention functioning, supporting the role of frontal control systems in neuroanatomical models of self-awareness.