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

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What works for whom in the management of diabetes in people living with dementia: A realist review. / Bunn, Frances; Goodman, Claire; Reece Jones, Peter et al.
In: BMC Medicine, Vol. 15, No. 1, 141, 28.07.2017.

Research output: Contribution to Journal/MagazineJournal articlepeer-review

Harvard

Bunn, F, Goodman, C, Reece Jones, P, Russell, B, Trivedi, D, Sinclair, A, Bayer, A, Rait, G, Rycroft-Malone, J & Burton, C 2017, 'What works for whom in the management of diabetes in people living with dementia: A realist review', BMC Medicine, vol. 15, no. 1, 141. https://doi.org/10.1186/s12916-017-0909-2

APA

Bunn, F., Goodman, C., Reece Jones, P., Russell, B., Trivedi, D., Sinclair, A., Bayer, A., Rait, G., Rycroft-Malone, J., & Burton, C. (2017). What works for whom in the management of diabetes in people living with dementia: A realist review. BMC Medicine, 15(1), Article 141. https://doi.org/10.1186/s12916-017-0909-2

Vancouver

Bunn F, Goodman C, Reece Jones P, Russell B, Trivedi D, Sinclair A et al. What works for whom in the management of diabetes in people living with dementia: A realist review. BMC Medicine. 2017 Jul 28;15(1):141. doi: 10.1186/s12916-017-0909-2

Author

Bunn, Frances ; Goodman, Claire ; Reece Jones, Peter et al. / What works for whom in the management of diabetes in people living with dementia : A realist review. In: BMC Medicine. 2017 ; Vol. 15, No. 1.

Bibtex

@article{f47519136b4b479c835b8c6fee2fd8a2,
title = "What works for whom in the management of diabetes in people living with dementia: A realist review",
abstract = "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.",
keywords = "Dementia, Diabetes, Realist review, Realist synthesis, Self-management",
author = "Frances Bunn and Claire Goodman and {Reece Jones}, Peter and Bridget Russell and Daksha Trivedi and Alan Sinclair and Antony Bayer and Greta Rait and Jo Rycroft-Malone and Christopher Burton",
year = "2017",
month = jul,
day = "28",
doi = "10.1186/s12916-017-0909-2",
language = "English",
volume = "15",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "BIOMED CENTRAL LTD",
number = "1",

}

RIS

TY - JOUR

T1 - What works for whom in the management of diabetes in people living with dementia

T2 - A realist review

AU - Bunn, Frances

AU - Goodman, Claire

AU - Reece Jones, Peter

AU - Russell, Bridget

AU - Trivedi, Daksha

AU - Sinclair, Alan

AU - Bayer, Antony

AU - Rait, Greta

AU - Rycroft-Malone, Jo

AU - Burton, Christopher

PY - 2017/7/28

Y1 - 2017/7/28

N2 - 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.

AB - 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.

KW - Dementia

KW - Diabetes

KW - Realist review

KW - Realist synthesis

KW - Self-management

U2 - 10.1186/s12916-017-0909-2

DO - 10.1186/s12916-017-0909-2

M3 - Journal article

C2 - 28750628

AN - SCOPUS:85026388134

VL - 15

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

IS - 1

M1 - 141

ER -