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What works for whom in the management of diabetes in people living with dementia: a realist review

BACKGROUND: Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was t...

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Autores principales: Bunn, Frances, Goodman, Claire, Reece Jones, Peter, Russell, Bridget, Trivedi, Daksha, Sinclair, Alan, Bayer, Antony, Rait, Greta, Rycroft-Malone, Jo, Burton, Christopher
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532771/
https://www.ncbi.nlm.nih.gov/pubmed/28750628
http://dx.doi.org/10.1186/s12916-017-0909-2
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author Bunn, Frances
Goodman, Claire
Reece Jones, Peter
Russell, Bridget
Trivedi, Daksha
Sinclair, Alan
Bayer, Antony
Rait, Greta
Rycroft-Malone, Jo
Burton, Christopher
author_facet Bunn, Frances
Goodman, Claire
Reece Jones, Peter
Russell, Bridget
Trivedi, Daksha
Sinclair, Alan
Bayer, Antony
Rait, Greta
Rycroft-Malone, Jo
Burton, Christopher
author_sort Bunn, Frances
collection PubMed
description BACKGROUND: Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD. METHODS: This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories and their validation with a purposive sample of stakeholders. Twenty-six stakeholders — user/patient representatives, dementia care providers, clinicians specialising in diabetes or dementia and researchers — took part in interviews, and 24 participated in a consensus conference. RESULTS: We included 89 papers. Ten focused on PLWD and diabetes, and the remainder related to people with either dementia, diabetes or other long-term conditions. We identified six context-mechanism-outcome configurations which provide an explanatory account of how interventions might work to improve the management of diabetes in PLWD. This includes embedding positive attitudes towards PLWD, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. An overarching contingency emerged concerning the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. CONCLUSIONS: Evidence highlighted the need for personalised care, continuity and family-centred approaches, although there was limited evidence that this happens routinely. This review suggests there is a need for a flexible service model that prioritises quality of life, independence and patient and carer priorities. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to their needs. TRIAL REGISTRATION: PROSPERO, CRD42015020625. Registered on 18 May 2015.
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spelling pubmed-55327712017-08-02 What works for whom in the management of diabetes in people living with dementia: a realist review Bunn, Frances Goodman, Claire Reece Jones, Peter Russell, Bridget Trivedi, Daksha Sinclair, Alan Bayer, Antony Rait, Greta Rycroft-Malone, Jo Burton, Christopher BMC Med Research Article BACKGROUND: Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD. METHODS: This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories and their validation with a purposive sample of stakeholders. Twenty-six stakeholders — user/patient representatives, dementia care providers, clinicians specialising in diabetes or dementia and researchers — took part in interviews, and 24 participated in a consensus conference. RESULTS: We included 89 papers. Ten focused on PLWD and diabetes, and the remainder related to people with either dementia, diabetes or other long-term conditions. We identified six context-mechanism-outcome configurations which provide an explanatory account of how interventions might work to improve the management of diabetes in PLWD. This includes embedding positive attitudes towards PLWD, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. An overarching contingency emerged concerning the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. CONCLUSIONS: Evidence highlighted the need for personalised care, continuity and family-centred approaches, although there was limited evidence that this happens routinely. This review suggests there is a need for a flexible service model that prioritises quality of life, independence and patient and carer priorities. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to their needs. TRIAL REGISTRATION: PROSPERO, CRD42015020625. Registered on 18 May 2015. BioMed Central 2017-07-28 /pmc/articles/PMC5532771/ /pubmed/28750628 http://dx.doi.org/10.1186/s12916-017-0909-2 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Bunn, Frances
Goodman, Claire
Reece Jones, Peter
Russell, Bridget
Trivedi, Daksha
Sinclair, Alan
Bayer, Antony
Rait, Greta
Rycroft-Malone, Jo
Burton, Christopher
What works for whom in the management of diabetes in people living with dementia: a realist review
title What works for whom in the management of diabetes in people living with dementia: a realist review
title_full What works for whom in the management of diabetes in people living with dementia: a realist review
title_fullStr What works for whom in the management of diabetes in people living with dementia: a realist review
title_full_unstemmed What works for whom in the management of diabetes in people living with dementia: a realist review
title_short What works for whom in the management of diabetes in people living with dementia: a realist review
title_sort what works for whom in the management of diabetes in people living with dementia: a realist review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532771/
https://www.ncbi.nlm.nih.gov/pubmed/28750628
http://dx.doi.org/10.1186/s12916-017-0909-2
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