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What Makes Institutional Long-Term Care the Most Appropriate Setting for People With Dementia? Exploring the Influence of Client Characteristics, Decision-Maker Attributes, and Country in 8 European Nations

Tucker, Sue; Brand, Christian; Sutcliffe, Caroline; Challis, David; Saks, Kai; Verbeek, Hilde; Cabrera, Esther; Karlsson, Staffan LU ; Leino-Kilpi, Helena and Stephan, Astrid, et al. (2016) In Journal of the American Medical Directors Association 17(5). p.9-465
Abstract

To explore the extent to which client characteristics, decision-maker attributes, and country influence judgments of institutional long-term care (ILTC) appropriateness for people with dementia. Design, setting, and participants: A total of 161 experts in dementia care from 8 European countries reviewed a series of 14 vignettes representing people with dementia on the cusp of ILTC admission and indicated the most appropriate setting in which to support each case in a simple discrete choice exercise: own home, very sheltered housing, residential home, or nursing home. At least 16 experts participated in each country (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden, and the United Kingdom). Measurements: Descriptive... (More)

To explore the extent to which client characteristics, decision-maker attributes, and country influence judgments of institutional long-term care (ILTC) appropriateness for people with dementia. Design, setting, and participants: A total of 161 experts in dementia care from 8 European countries reviewed a series of 14 vignettes representing people with dementia on the cusp of ILTC admission and indicated the most appropriate setting in which to support each case in a simple discrete choice exercise: own home, very sheltered housing, residential home, or nursing home. At least 16 experts participated in each country (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden, and the United Kingdom). Measurements: Descriptive statistics were used to characterize the experts and their placement preferences. Logistic regression modeling was used to explore the extent to which the sociodemographic and clinical characteristics of people with dementia, and the profession, workplace, and country of decision-makers were associated with ILTC recommendation. Results: Client characteristics, decision-maker attributes, and country all seemed to play a part in influencing professionals' perceptions of the appropriateness of ILTC for people with dementia. Expert decision-makers were more likely to recommend ILTC for individuals who required help with mobility or had multiple care needs, and appeared to give more weight to carers' than clients' wishes. Community-based social workers were less likely than other professional groups to favor ILTC placement. Experts in Finland, Germany, and the United Kingdom were less likely to recommend ILTC than experts in France, the Netherlands, and Estonia; experts in Sweden and Spain took an intermediate position. Conclusion: This study provides new understanding of the factors that shape professionals' perceptions of ILTC appropriateness and highlights the need to construct multifaceted models of institutionalization when planning services for people with dementia. It also has several important clinical implications (including flagging interventions that could decrease the need for ILTC), and provides a basis for enhancing professionals' decision-making capabilities (including the greater involvement of clients themselves).

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published
subject
keywords
Care home placement, Decision-making, Dementia, Institutionalization, Long-term care
in
Journal of the American Medical Directors Association
volume
17
issue
5
pages
9 - 465
publisher
Elsevier
external identifiers
  • Scopus:84963861104
ISSN
1525-8610
DOI
10.1016/j.jamda.2016.02.025
language
English
LU publication?
yes
id
e0c84e88-b660-4fa6-b265-2f9da3858d77
date added to LUP
2016-05-10 13:17:50
date last changed
2016-11-04 10:16:57
@misc{e0c84e88-b660-4fa6-b265-2f9da3858d77,
  abstract     = {<p>To explore the extent to which client characteristics, decision-maker attributes, and country influence judgments of institutional long-term care (ILTC) appropriateness for people with dementia. Design, setting, and participants: A total of 161 experts in dementia care from 8 European countries reviewed a series of 14 vignettes representing people with dementia on the cusp of ILTC admission and indicated the most appropriate setting in which to support each case in a simple discrete choice exercise: own home, very sheltered housing, residential home, or nursing home. At least 16 experts participated in each country (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden, and the United Kingdom). Measurements: Descriptive statistics were used to characterize the experts and their placement preferences. Logistic regression modeling was used to explore the extent to which the sociodemographic and clinical characteristics of people with dementia, and the profession, workplace, and country of decision-makers were associated with ILTC recommendation. Results: Client characteristics, decision-maker attributes, and country all seemed to play a part in influencing professionals' perceptions of the appropriateness of ILTC for people with dementia. Expert decision-makers were more likely to recommend ILTC for individuals who required help with mobility or had multiple care needs, and appeared to give more weight to carers' than clients' wishes. Community-based social workers were less likely than other professional groups to favor ILTC placement. Experts in Finland, Germany, and the United Kingdom were less likely to recommend ILTC than experts in France, the Netherlands, and Estonia; experts in Sweden and Spain took an intermediate position. Conclusion: This study provides new understanding of the factors that shape professionals' perceptions of ILTC appropriateness and highlights the need to construct multifaceted models of institutionalization when planning services for people with dementia. It also has several important clinical implications (including flagging interventions that could decrease the need for ILTC), and provides a basis for enhancing professionals' decision-making capabilities (including the greater involvement of clients themselves).</p>},
  author       = {Tucker, Sue and Brand, Christian and Sutcliffe, Caroline and Challis, David and Saks, Kai and Verbeek, Hilde and Cabrera, Esther and Karlsson, Staffan and Leino-Kilpi, Helena and Stephan, Astrid and Soto, Maria E. and Meyer, Gabriele and Renom-Guiteras, Anna and Sauerland, Dirk and Wübker, Ansgar and Bremer, Patrick and Hamers, Jan P H and Afram, Basema and Beerens, Hanneke C. and Bleijlevens, Michel H C and Zwakhalen, Sandra M G and Ruwaard, Dirk and Ambergen, Ton and Hallberg, Ingalill Rahm and Emilsson, Ulla Melin and Bökberg, Christina and Lethin, Connie and Jolley, David and Bowns, Ian and Roe, Brenda and Burns, Alistair and Koskenniemi, Jaana and Suhonen, Riitta and Viitanen, Matti and Arve, Seija and Stolt, Minna and Hupli, Maija and Tiit, Ene Margit and Leibur, Jelena and Raamat, Katrin and Armolik, Angelika and Zabalegui, Adelaida and Risco, Ester and Alvira, Carme and Farre, Marta and Miguel, Susana and Soto, Maria and Milhet, Agathe and Sourdet, Sandrine and Gillette, Sophie and Vellas, Bruno and RightTimePlaceCare Consortium, Consortium},
  issn         = {1525-8610},
  keyword      = {Care home placement,Decision-making,Dementia,Institutionalization,Long-term care},
  language     = {eng},
  month        = {05},
  number       = {5},
  pages        = {9--465},
  publisher    = {ARRAY(0x96bf020)},
  series       = {Journal of the American Medical Directors Association},
  title        = {What Makes Institutional Long-Term Care the Most Appropriate Setting for People With Dementia? Exploring the Influence of Client Characteristics, Decision-Maker Attributes, and Country in 8 European Nations},
  url          = {http://dx.doi.org/10.1016/j.jamda.2016.02.025},
  volume       = {17},
  year         = {2016},
}