Suchergebnisse

The United States (US) currently has the most confirmed cases of COVID-19 of any country. Yet, adequate testing for the virus remains a major issue. Approximately 51.6 million Americans are over the age of 65 and 56 percent of adults over 65 are living with two or more chronic conditions (23 percent have 3 or more). Given the higher risk of death and complications associated with advanced age and underlying health conditions, COVID-19 has had an immense impact upon LTC in the United States. Yet, the level and intensity of impact has been sporadic in application. This is due in part to a highly disparate and fractured long-term care system and perennial systemic challenges that have been exacerbated by the pandemic. In terms of financing care, the US relies on a mix of public and private funding sources. Further, individual states and the federal government have overlapping responsibility for funding and regulation of care. Meanwhile, fragmentation between financing and ownership of health care entities versus long-term care entities hinders coordinated delivery of care across sectors; and social sectors and health care sectors are also not integrated. The challenges of the system's design suggest that both a near-term and long-term response is needed to mitigate the impact of COVID-19 on the approximately 13 million Americans who require long-term care. This report provides an overview of the current challenges facing LTC and outlines several potential policy responses to the pandemic as well as for life post-pandemic.

A randomized clinical trial was conducted over a three year period to compare the effectiveness of religiously-integrated cognitive behavioural therapy (RCBT) with conventional CBT (CCBT) for the treatment of a major depressive disorder (MDD). A total of 132 participants with chronic medical illness and MDD were enrolled in the trial (CCBT=67, RCBT=65). Ten 50-minute treatment sessions were delivered by master's level certified counsellors over 12 weeks. All sessions were delivered remotely, largely over the telephone. In this review, we describe the findings from this trial, including the effects on depressive symptoms, positive emotions, and immune and endocrine markers in blood and urine. We also examine the effects of treatment based on genotype, in particular polymorphisms of the serotonin transporter, serotonin receptor, and monoamine oxidase genes. Lessons learned from conducting this trial are also discussed. Although not designed as a non-inferiority trial, the results suggest that RCBT is as effective as standard CBT in the treatment of major depression in this setting, especially among highly religious clients, and can be delivered by appropriately trained chaplains.

More direct inclusion of informal caregivers (i.e., family, friends) in patients' care will make care more patient- and family-centered and has the potential to improve overall quality of care for patients. We need to understand what potentially comprises "inclusive care" so that we can define what "inclusive care" is and develop targets for care quality metrics. We conducted a critical literature review to identify key components of "caregiver inclusion." Focusing on extant literature from 2005 to 2017, 35 papers met inclusion criteria. Directed content analysis with constant comparison was used to identify major themes related to a concept of "inclusive care." Our analysis indicates that "inclusive care" entails five components: clear definition of caregiver role, system level policies for inclusion, explicit involvement of caregiver, provider assessment of caregiver capability, and mutuality in caregiver–provider communication. We discuss the evidence behind these five components using the Donabedian health care quality conceptual model.