Introduction
Alzheimer’s and dementia are neurological diseases common to people in old age. According to Schulz et al. (2020), about 10% of people 65 years and above suffer from Alzheimer’s, while more than 55 million individuals worldwide have dementia. There are several ways in which patients with dementia and Alzheimer’s disease are handled in different countries. Some countries prefer long-term health facilities to home care services and vice versa. The difference between the two healthcare services is depicted in the outcomes. The two methods have different levels of effectiveness in the management of patients. According to Cadieux et al. (2018), long-term facility care is considered less effective in managing patients because the caregivers and patients are highly depressed compared to home care services. This work will compare and contrast the efficacy of community-based and long-term care interventions meant to help and retain individuals with Alzheimer’s disease and dementia, as well as the well-being of the caregivers to avoid burnout. The PICOT question is “In the care of Alzheimer’s and dementia patients (P), does integrated community-based care (I) as compared to being in a long-term care facility (C) improve outcome (O) throughout the remainder of their lives (T).”
Background of Studies
This paper assessed two research projects on long-term care facilities and integrated community care. The first study addresses the effectiveness of community-based care services for dementia and Alzheimer’s patients. Specifically, the paper contains information about a Dutch organization offering community-based care services for adults with dementia and Alzheimer’s (O’Connor et al., 2022). The study’s goal was to determine how well these patients were managed by community-based care and to assist in identifying gaps and potential improvement areas. The study applies to nurses because they must deliver evidence-based treatment, and the report aims to give readers additional knowledge about patient management. On the other hand, the other article focuses on assessing the effects of putting a family member with dementia and Alzheimer’s disease in a long-term care facility. The study aims to determine how long-term facility care affects the health of dementia and Alzheimer’s patients (Schulz et al., 2020). Moreover, this research is very important to the nursing sector since it equips nurses with the knowledge they need to choose the appropriate medical institution for patient management based on data from research.
How Articles Support the Nursing Practice Problem
This paper will contain comparison information on integrated community-based care and long-term-based facility care from various studies. This work will present a summative assessment of the two care methods presented by the review studies. The summative information will be used to answer the PICOT question since the study will involve the difference in effectiveness in managing dementia and Alzheimer’s disease presented in the two papers. The summative information on the two methods will contain the modes of the approach adopted by the two methods to manage individuals with dementia and Alzheimer’s disease. This will involve a vivid description of the advantages and disadvantages of both healthcare methods. Therefore, the information will be used to answer the PICOT question comprehensively with evidence-based approaches presented in the two studies.
The articles have presented interventions for dementia and Alzheimer’s caregiving in the community and long-term care facilities for the same neural disorders. The comparison groups presented in the articles have been derived from the outcomes of the long-term care facilities and integrated care interventions. Therefore, the comparison groups and the interventions presented in the articles are similar to the interventions required in the PICOT question of this study. However, for the comparison groups and interventions presented in the two articles to answer the PICOT question or address the interventions identified in the PICOT question, they must be compared for their advantages and disadvantages.
Method of Studies
There were several methods used in the review articles of this study. In the first article, the researchers interviewed the professionals of the Dutch organization, medical personnel with qualifications and experience in managing patients with dementia or Alzheimer’s disease (O’Connor et al., 2022). Moreover, the researchers of this study interviewed the home caregivers, including the relatives of the subject patients of this research. The interview questions were predicated on inquiring about the care methods they used to handle the patients and the proposed healthcare methods they thought were more effective in managing dementia or Alzheimer’s patients. On the other hand, the second article used the framework approach to conduct group interviews comprising community service providers and individuals who conducted Nav-CARE Canadian community care to manage dementia and Alzheimer’s disease. Lastly, the other article used a cross-sectional observational study on dementia patients, where qualitative information was collected using The Equanimity, Peace, and Acceptance subscale of the Cancer Experience Scale. The scale was used to examine the patient’s condition and the association between ACP and HCP acceptance and patients’. Quantitative information on the long-term care facility was collected from 180 patients’ follow-up activities which were conducted for 18 months (Schulz et al., 2020). The data was analyzed to determine dementia and Alzheimer’s patients’ management practices from the contact information of caregivers, relatives, and patients.
The interview method of data collection is considered better than other methods because it gives a real-time response and can accommodate both literate and illiterate respondents. However, interviews can be biased and thus give unrealistic information. The cross-sectional observational study method is less costly and time-consuming; however, the link between the outcome and the exposure of the cross-sectional observational study cannot be determined simultaneously (Chiu et al., 2020). The framework approach method is simple to conduct; however, the log frame used in the study may contain vague planning measures which affect the outcome.
Results of Studies
The results obtained from both health care methods, integrated community care and long-term facility care, were compared to depict the most effective method to manage dementia and Alzheimer’s patients. The long-term care facility presented depression among caregivers and patients as the major concern in managing dementia and Alzheimer’s. Depression was prevalent among nurses, caregivers, and patients in the facilities. The facilities used pharmacological interventions to control depression among the research participants as the main care setup. A depression score of 15 was recorded from the CES-D scale in the facility. According to O’Connor et al. (2022), the nurses’ and patients’ depression scores in the state-trait inventory ranged between 20-25. The depression affected the caregivers with patient relatives; therefore, antidepressants and anxiolytics pharmacological therapy were less efficient in relieving their depression.
On the other hand, community-based care depicted more positive implications for managing dementia and Alzheimer’s patients. However, there were few family, community, and patient relationship strains (Schulz et al., 2020). This interventional method allowed the patients to interact, thus, minimizing the chances of depression depicted in the long-term care facility intervention method. This method met the most crucial needs of the patients since maximum care for the patients was provided. According to the findings, integrated community care is a more practical method of managing patients with complicated diseases and comorbidities, particularly as they age (Schulz et al., 2020). This suggests that nurses rethink their decision to overuse community care services and confine these patients to care facilities. These studies have depicted that nurses should consider recommending the community-based care method to manage dementia and Alzheimer’s disease (Warner et al., 2021). Therefore, the findings of this research imply that nursing practice should have evidence-based care approaches to managing complex disorders.
Ethical Considerations
Several ethical considerations should be upheld by the researchers while researching. This is because the research involves personal information vital to the participants’ privacy (Arifin, 2018). Some ethical considerations that need to be upheld in research include confidentiality and informed consent before conducting the research. Priority should be given to preserving the dignity of research participants. Before the study, participants’ full consent should be obtained. Participants in the study must have their privacy protected. The research data should be kept secret to a sufficient degree. Before the participants participated in the study, their consent was obtained (O’Connor et al., 2022). It is evident from the research that all participants gave their consent to participate in the study, and none were forced to do so. Furthermore, confidentiality must always be upheld in all studies. The research’s concealment of the participants’ identities provides a crystal-clear example of the ethical decisions that were made while conducting the study.
Outcomes Comparison
The anticipated outcome of the PICOT question of this research was predicated on the conventional improvement of the outcome of the management of dementia and Alzheimer’s disease implicated by the integrated community-based care compared to the care provided by the long-term care facility. The outcome of the PICOT question proposed that integrated community-based care is the most convenient in managing dementia and Alzheimer’s patients compared to the long-term care facility. Similarly, the outcome of the articles has depicted that long-term care facility is challenged by depression among caregivers, nurses, and patients, which can only be combated by medication. However, the medications were not fully effective for some participants. On the other hand, integrated community-based care depicted effective interventions in managing dementia and Alzheimer’s patients by providing maximum needs and care. Therefore, the study has proved the anticipated outcomes of the PICOT question of this study.
Proposed Evidence-Based Practice Change
The link between the PICOT question, the research articles, and the nursing practice problem of this study is the two neuro disorders, dementia, and Alzheimer’s disease. All are interested in the management of dementia and Alzheimer’s disease patients. The PICOT question compares the integrated community-based care and long-term care facilities in the management of dementia and Alzheimer’s disease patients; the research articles contain information on integrated community-based care and long-term care facilities in the management of dementia and Alzheimer’s disease patients, while the nursing practice problem is interested in the management of integrated community-based care and long-term care facilities in the management of dementia and Alzheimer’s disease patients which it seeks to determine from the summative review of the articles under the guidance of the PICOT question. According to this setting, cognitive behavioral therapy would be proposed as it is a talking therapy that enhances understanding of people and helps the missing relationship between actions and thoughts and then uses that knowledge to make significant changes in their life. It has become a standard method of assisting people in managing their mental problems, such as depression. This method can serve as the convectional alternative change for the long-term care facilities method for dementia and Alzheimer’s.
Conclusion
In conclusion, individuals with dementia and Alzheimer’s need proper care and management, especially depression, which is an outstanding menace among them. This study shows that integrated community care is the most effective intervention to combat depression and manage dementia and Alzheimer’s patients. However, future studies should consider the effectiveness of cognitive behavioral therapy in managing dementia and Alzheimer’s patients.
References
Arifin, S. R. M. (2018). Ethical considerations in the qualitative study. International Journal of Care Scholars, 1(2), 30–33.
Cadieux, M. A., Garcia, L. J., & Patrick, J. (2018). Needs of people with dementia in long-term care: a systematic review. American Journal of Alzheimer’s Disease & Other Dementias®, 28(8), 723-733.
Chiu wu, C.-H., Perng, S.-J., Shi, C.-K., & Lai, H.-L. (2020). Advance care planning and advance directives: A multimedia education program in community-dwelling older adults. Journal of Applied Gerontology, 39(8), 811–819. Web.
O’Connor, N., Fox, S., Kernohan, W. G., Drennan, J., Guerin, S., Murphy, A., & Timmons, S. (2022). A scoping review of the evidence for community-based dementia palliative care services and their related service activities. BMC Palliative Care, 21(1), 1-20.
Schulz, R., Belle, S. H., Czaja, S. J., McGinnis, K. A., Stevens, A., & Zhang, S. (2020). Long-term care placement of dementia patients and caregiver health and well-being. Jama, 292(8), 961-967.
Warner, G., Kervin, E., Pesut, B., Urquhart, R., Duggleby, W., & Hill, T. (2021). How inner and outer settings affect the implementation of a community-based innovation for older adults with a serious illness: A qualitative study. BMC Health Services Research, 21(1), 1–13.