Aim. Ensuring older adults' involvement in their care is accepted as good practice and is vital, particularly for people with dementia, whose care and treatment needs change considerably over the course of the illness. However, involving family members in decision making on people's behalf is still practically difficult for staff and family. The aim of this review was to identify and appraise the existing quantitative evidence about family involvement in decision making for people with dementia living in residential aged care.Methods. This Joanna Briggs Institute (JBI) meta-synthesis assessed studies that investigated involvement of family members in decision making for people with dementia in residential aged care settings. Whilst quantitative and qualitative studies were included in the review, this paper presents the quantitative findings. A comprehensive search of 15 electronic databases was performed. The search was limited to papers published in English, from 1990 to 2013. Twenty six studies were identified as being relevant; ten were quantitative, with one mixed-method study. Two independent reviewers assessed the studies for methodological validity and extracted the data using the JBI Meta Analysis of Statistics Assessment and Review Instrument (JBIMAStARI). The findings were synthesised and presented in narrative form. Conclusions.The results identified patterns within and variables associated with surrogate decision making, which all highlight the complexity and variation regarding family involvement.Attention needs to be paid to supporting family members in decision making in collaboration with staff. Word count: 269Keywords: decision making; dementia; family; residential aged care; systematic review Care Home Minimum Standards make frequent reference to "residents and their representatives" being informed, consulted, and involved in decision making and care planning, among other decisions in the facility. 8,9 In the United States, the Federal Requirements for Long Term Care Facilities 9 commonly makes reference to "the resident or their representative", the "legal representative", or "family member" in regard to information, consent, and care planning. Other countries similarly, both implicitly and explicitly, refer to representatives, including family, being informed and involved in planning and decision making. However, the enactment of these standards is not consistent across contexts.There have also been attempts to develop best practice approaches to involving family members in the care of older people in residential care. In Australia, for example, participation of family members in the care of older people is also highlighted in the Palliative ApproachGuidelines for RAC and Community. 10,11 Further, the recent development of consumer focused documents in Australia which highlight the role of family members and proxy decision makers in contributing to care decisions for planning for end of life with dementia is a good example of the growing policy context which supports the involvemen...
Recent research demonstrates that involvement in productive activities, particularly volunteering, has important societal and individual benefits in the contemporary aging environment. However, less attention has been paid to the structural dimension of volunteering or what encourages or discourages older people regarding volunteering. The authors present the findings from a two-phase Australian case study that explores the incentives and barriers to volunteering by those aged 50 and older, all members of a national seniors organization. Results suggest that governments and organizations need to consider many issues if more seniors are to be attracted to volunteering. Ensuring appropriate incentives to encourage volunteering was viewed as particularly important, with incentives including the need for more training, more flexible and diverse options, and more opportunities for intergenerational volunteering. Potential barriers included negative perceptions of volunteer activities, fear of encountering ageism, and concerns about the increasingly regulatory organizational environment.
Implications for research relate to the development of a more comprehensive theory of resilience in family caregivers that can be used to develop and rigorously evaluate reliable and valid measures of resilience in line with that theory. Further, well-designed, sufficiently powered intervention studies informed by theory are needed.
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