Persons with Dementia Living at Home or in Nursing Homes in Nine Swedish Urban or Rural Municipalities.

Connie Lethin,Ingalill Rahm Hallberg,Lottie Giertz,Emme-Li Vingare

doi:10.3390/healthcare7020080

Abstract

The methodology from the “RightTimePlaceCare” study of dementia care was tested locally in terms of relevance, acceptability and attrition. Comparing persons with dementia (PwDs) receiving home care (HC) with PwDs living in nursing homes (NHs), in urban versus rural areas, regarding their health conditions and informal caregiver burden was also done. Standardized measurements regarding sociodemographic, and physical and mental health was used. Questions related to legal guardianship were added. Interviews were conducted with PwDs and their caregivers in HC (n = 88) and in NHs (n = 58). Bivariate and multivariate logistic regression analysis was used. The attrition rate was higher in HC. In the bivariate regression model, for HC and NH, living at home was significantly associated with more severe neuropsychiatric symptoms (p ≤ 0.001) and being cared by a spouse (p = 0.008). In NH, the informal caregivers were significantly younger (p = 0.003) and living in rural areas (p = 0.007) and more often in paid work (p ≤ 0.001). In the multivariate regression model, informal caregivers were significantly younger (p = 0.007) when caring for a PwD in an NH and caregiver burden was significantly higher in HC and in urban areas (p = 0.043). Legal guardianship was very low. Professionals should acknowledge that PwDs in HC have more behavioural problems and caregivers in urban areas report higher caregiver burden.

Highlights

One major societal challenge in Sweden and worldwide is the rapidly growing older population implying an increasing prevalence of dementia and, a greater need for care [1,2,3]
We studied factors influencing the person with dementias institutionalization at the time of admission to a nursing home and the availability and utilization of care and services throughout the dementia trajectory as well as professional providers’ educational level
Persons with dementia living at home had significantly more severe neuropsychiatric symptoms and informal caregivers had significantly higher experienced burden, compared to those living in nursing homes

Summary

Introduction

One major societal challenge in Sweden and worldwide is the rapidly growing older population implying an increasing prevalence of dementia and, a greater need for care [1,2,3]. Older people are at higher risk for various chronic diseases and dementia is among the most common age-related condition [4,5]. The person will be more dependent on informal and formal care to manage activities of daily living (ADLs) [7]. Neurocognitive symptoms occur throughout the dementia trajectory and the most common symptoms are agitation, mood disorders and psychosis [8]. Persons with dementia will develop one or more behavioural and psychological symptoms of dementia (BPSD) with an impact on quality of life (QoL) and caregiver burden. At some point depressive symptoms occur during the course of Healthcare 2019, 7, 80; doi:10.3390/healthcare7020080 www.mdpi.com/journal/healthcare

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