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Assessment of Support Interventions in Dementia: Methodological and Empirical Studies
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Dementia means a continuous deterioration of abilities and has a large impact on the persons affected as well as on family members and others close to the persons with dementia. Interventions aimed at this population in order to support and alleviate the often straining situation may be of great importance. There is a need to increase the knowledge and understanding of the impact and consequences of these interventions, both at an individual level and at a societal level. The demand for information concerning, e.g., economic and medical impact of technologies and interventions within health care is increasing. Assessment of technologies and interventions in dementia is related to certain methodological issues. The overall aim of this thesis is to contribute to the development of methodological knowledge concerning assessment studies and understanding of support interventions in dementia.

This thesis work includes four studies that examine methodological aspects of assessment of support interventions in dementia and also report empirical research on the perception of support interventions from the perspectives of family caregivers of persons with dementia. In study I, an assessment model for assistive technology (AT) interventions in dementia was developed. In study II, part of the assessment model is applied, and a process evaluation of the AT intervention is presented. Study III examines family caregivers’ perception of the importance of different types of support and services. In the final study, study IV, a well‐acknowledged methodological challenge within the field of assessment in dementia is addressed: measuring health‐related quality of life (HRQoL). The studies are based on different data materials.

An assessment model of AT interventions was developed that includes health economic evaluation from a societal perspective as well as evaluation of the intervention process. The perspectives of both persons with dementia and their relatives were incorporated in the model. The process evaluation was applied in study II in order to study the relatives’ perception of an AT intervention process. Assistive technology interventions in dementia may be of great significance for the relatives. By performing the process evaluation, several important aspects that need to be acknowledged in AT intervention processes in dementia were identified.

Family caregivers of persons with dementia perceived different types of support/services within the comprehensive areas of counselling, relief and information as very important. Knowledge of the caregivers’ preferences is significant so that more directed support interventions may be provided.

One specific methodological issue was addressed in study IV. The results of study IV showed that there were large differences in the results of cost‐effectiveness analyses depending on whether patient self‐ratings or proxy ratings (ratings of persons close to the patient) of patient HRQoL were used for the same analysis. These differences in the results could ultimately have an important impact on decision making and resource allocation.

Support interventions aimed at persons with dementia and their relatives may be of great value. Conducting assessment studies of technologies and interventions within health care is important in order to increase the knowledge concerning, e.g., economic and medical impact. Assessment studies of support interventions dementia entails methodological issues that need to be addressed. There is a need for increased knowledge within this field and suggestions on methodology are made.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2010. , 68 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1170
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-54312ISBN: 978-91-7393-434-3 (print)OAI: oai:DiVA.org:liu-54312DiVA: diva2:302673
Public defence
2010-04-09, Berzeliussalen, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2010-03-09 Created: 2010-03-09 Last updated: 2017-07-06Bibliographically approved
List of papers
1. Health economic and process evaluation of AT interventions for persons with dementia and their relatives - A suggested assessment model
Open this publication in new window or tab >>Health economic and process evaluation of AT interventions for persons with dementia and their relatives - A suggested assessment model
Show others...
2007 (English)In: Technology and Disability, ISSN 1055-4181, Vol. 19, no 2-3, 61-71 p.Article in journal (Refereed) Published
Abstract [en]

There is growing interest in assistive technology (AT) as a means of enabling participation in everyday activities for persons with dementia and their relatives. Health economic assessment of AT in dementia is of importance due to the consequences of the disease for both patients and relatives and to the high societal costs for dementia care. The aim of this article is to outline a model for assessment of AT interventions for persons with dementia. The model expands existing assessment models as it also includes evaluation of the intervention process. Methodological challenges and possibilities in making health economic assessments, including outcomes and costs, as well as process evaluation, are discussed in the article. © 2007 IOS Press. All rights reserved.

Keyword
Technology assessment, model, assistive technology, dementia, relatives, cost-effectiveness, process evaluation
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-37149 (URN)33797 (Local ID)33797 (Archive number)33797 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2011-01-11
2. Perception and significance of an assistive technology intervention - the perspectives of relatives of persons with dementia
Open this publication in new window or tab >>Perception and significance of an assistive technology intervention - the perspectives of relatives of persons with dementia
2013 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 35, no 18, 1519-1526 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to examine relatives' perception of an assistive technology intervention aimed at persons with dementia (PwDs) and their relatives, and to examine whether, and how, experiences of the intervention process differed between relatives valuing the intervention to be of high, and relatives perceiving it to be of low significance. Method: A total of 47 relatives of PwDs within the Swedish Technology and Dementia project were interviewed telephonically using a modified version of the Patient perspective on Care and Rehabilitation process instrument. A total of 46 participants were divided into two groups depending on whether they valued the intervention to be of great significance (GS group; N = 33) or of some/no significance (SNS group; N = 13). Results: Several aspects of the intervention were perceived as highly important, e.g. being shown consideration and respect, and having somewhere to turn. The results indicate that relatives in the GS group perceived certain aspects of the intervention process as highly fulfilled to a larger extent than did relatives in the SNS group. Conclusions: This study illustrates how process evaluations can be used to increase the understanding and to identify improvement aspects of interventions.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keyword
Assistive technology, caregiving, dementia, process evaluation, relatives
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54310 (URN)10.3109/09638288.2012.743603 (DOI)000322657900004 ()
Available from: 2010-03-09 Created: 2010-03-09 Last updated: 2017-12-12
3. Support/services among family caregivers of persons with dementia - perceived importance and services received
Open this publication in new window or tab >>Support/services among family caregivers of persons with dementia - perceived importance and services received
2010 (English)In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 25, 240-248 p.Article in journal (Refereed) Published
Abstract [en]

Conclusion: The results from this study suggest that there is almost no difference between groups of caregivers experiencing higher and lower NI regarding their perception of what are important types of support/services. The caregivers rated different types of support/services within the areas of information, relief and counselling as very important.

Place, publisher, year, edition, pages
John Wiley & Sons, Ltd., 2010
Keyword
dementia; family caregiving; service; support; EUROFAMCARE
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54133 (URN)10.1002/gps.2328 (DOI)000275523300004 ()
Available from: 2010-02-24 Created: 2010-02-24 Last updated: 2017-12-12
4. Could the choice of patient versus proxy ratings for assessing quality of life in dementia affect resource allocation in health care?
Open this publication in new window or tab >>Could the choice of patient versus proxy ratings for assessing quality of life in dementia affect resource allocation in health care?
2012 (English)In: Farmeconomia: Health economics and therapeutic pathways, ISSN 1721-6915, Vol. 13, no 1, 25-31 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this paper is to demonstrate how the choice of patient versus proxy ratings of patient health-related quality of life (HRQoL) in dementia, for use in cost-effectiveness analyses (CEAs), could potentially affect resource allocation in health care.

METHODS:A model of Alzheimer’s disease (AD) based on cognitive ability was used to assess the consequences of using HRQoL ratings from either patients themselves or proxies if a new treatment was to be introduced. The model was based on previously published data on costs related to AD stages as well as HRQoL ratings from AD patients and from their caregivers as proxy raters.

RESULTS:The results show that there can be large differences in the results of the CEAs depending on whether the ratings of patients’ HRQoL were made by the patients themselves or by the proxy. When patient self-ratings of HRQoL were used, the cost/quality-adjusted life year (QALY) gained was much higher as compared to the scenario when proxy ratings were used for the same analysis.

CONCLUSIONS: The choice of patient self-ratings compared to proxy ratings of patients’ HRQoL can have a substantial effect on the results of CEAs. These differences in results may have an important impact on decision making and, ultimately, on resource allocation. In order to critically appraise the results of CEA studies in dementia we advise that both patient and proxy ratings are used in the CEA. To decide on methodology it is of great importance that focus is directed towards determining the most valid way to measure HRQoL in AD.

Place, publisher, year, edition, pages
SEEd, 2012
Keyword
Patient ratings; Proxy ratings; Dementia; Quality of Life; Resource allocation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-80152 (URN)10.7175/fe.v13i1.102 (DOI)
Note

The previous status of this article was Manuscript.

Available from: 2012-08-21 Created: 2012-08-21 Last updated: 2017-02-09Bibliographically approved

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