National Ageing Research Institute, Parkville, Vic., Australia.
Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia.
Health Soc Care Community. 2020 Mar;28(2):475-484. doi: 10.1111/hsc.12880. Epub 2019 Oct 23.
Global population ageing has meant a rapid increase in the numbers of older people with dementia, most of whom live in their own homes. Staying at home is an important determinant of health and well-being. As care needs increase, the quality of community support which older people receive directly influences their capacity to remain in their own homes. While many are supported informally by family carers, formal support provided by home care workers often enables them to remain at home for longer period. However, providing community-based care for people with dementia can be challenging. Workers often lack training in dementia-specific care for clients with increasingly complex needs, and typically work without direct supervision. As the demand for person-centred home care for people with dementia increases, specialist dementia training for home care workers is urgently needed. In this qualitative study, we used in-depth interviews of a purposive sample, comprising 15 family carers and four older people with dementia, to understand the experience of receiving community care. Data analysis was guided by Braun and Clarke's approach to thematic analysis and revealed the following five overlapping themes, relating to home care workers' understanding of dementia, person-centred care, communication and rapport, mutual collaboration, and the influence of organisational constraints on continuity of care. Although participants acknowledged that service providers operated under challenging circumstances, they were frustrated with home care workers' lack of dementia knowledge and inconsistent staff rostering. Conversely, an understanding of the lived experience of dementia, effective communication and rapport, and continuity of care contributed significantly to a positive experience of receiving care. The findings of this study will be used to inform the essential elements of a training program aimed at enabling and empowering a skilled, specialist home care workforce to support older people with dementia to live well at home for as long as possible.
全球人口老龄化导致痴呆症患者人数迅速增加，其中大多数人居住在自己家中。居家是健康和幸福的重要决定因素。随着护理需求的增加，老年人所获得的社区支持的质量直接影响他们留在自己家中的能力。虽然许多人得到了家庭护理者的非正式支持，但家庭护理工作者提供的正式支持通常使他们能够更长时间地留在自己家中。然而，为痴呆症患者提供社区护理可能具有挑战性。护理人员通常缺乏针对客户不断增加的复杂需求的痴呆症特定护理培训，并且通常在没有直接监督的情况下工作。随着对痴呆症患者的以人为主的家庭护理需求的增加，迫切需要为家庭护理工作者提供专门的痴呆症培训。在这项定性研究中，我们使用了深度访谈的方法，对一个有目的的样本进行了访谈，其中包括 15 名家庭护理者和 4 名患有痴呆症的老年人，以了解他们接受社区护理的体验。数据分析遵循 Braun 和 Clarke 的主题分析方法，揭示了五个重叠的主题，涉及家庭护理人员对痴呆症的理解、以人为主的护理、沟通和融洽关系、相互协作以及组织约束对连续性护理的影响。尽管参与者承认服务提供者在具有挑战性的情况下运作，但他们对家庭护理人员缺乏痴呆症知识和不稳定的员工轮班感到沮丧。相反，对痴呆症生活体验的理解、有效的沟通和融洽关系以及连续性护理对获得护理的积极体验有重大贡献。本研究的结果将用于为培训计划提供信息，该计划旨在使一支熟练的、专业的家庭护理人员队伍能够增强能力，支持患有痴呆症的老年人尽可能长时间地在家中过上健康幸福的生活。
