Preferences for Living Arrangements in Dementia: A Discrete Choice Experiment.
Journal
PharmacoEconomics - open
ISSN: 2509-4254
Titre abrégé: Pharmacoecon Open
Pays: Switzerland
ID NLM: 101700780
Informations de publication
Date de publication:
23 Nov 2023
23 Nov 2023
Historique:
accepted:
02
11
2023
medline:
23
11
2023
pubmed:
23
11
2023
entrez:
23
11
2023
Statut:
aheadofprint
Résumé
Dementia affects about 55 million people worldwide. Demographic change and shifting lifestyles challenge the organization of dementia care. A discrete choice experiment (DCE) was conducted to elicit preferences for living arrangements in dementia in urban and rural regions of Germany. Preliminary work included review of previous literature and focus groups. The DCE consists of seven attributes (group size, staff qualifications, organization of care, activities offered, support of religious practice, access to garden, consideration of food preferences) with three levels each. Individuals from the general population between the ages of 50 and 65 years were identified through population registration offices in three rural municipalities and one urban area, and 4390 individuals were approached via postal survey. A hierarchical Bayesian mixed logit model was estimated and interactions with sociodemographic characteristics were investigated. A total of 428 and 412 questionnaires were returned by rural and urban respondents, respectively. Access to a garden was perceived as the most important attribute (average importance 36.0% in the rural sample and 33.4% in the urban sample), followed by consideration of food preferences (15.8%, 17.8%), staff qualification (14.6%, 15.3%), care organization (11.4%, 12.3%), group size (12.2%, 11.1%), and range of activities (8.0%, 10.1%). The attribute relating to religious practice was given the least importance (2.1%, 0%). Preferences vary according to gender, age, religious beliefs, experience as an informal caregiver, and migrant background. Heterogeneous preferences for living arrangements for people with dementia were identified. The expansion of concepts with access to natural environments for persons with dementia might be a viable option for the formal care market in Germany. Further research is needed to meet the challenges of setting up and designing innovative living arrangements for people with dementia. Preferences vary by gender, age, religious beliefs, experience as an informal caregiver, and migrant background.
Sections du résumé
BACKGROUND
BACKGROUND
Dementia affects about 55 million people worldwide. Demographic change and shifting lifestyles challenge the organization of dementia care. A discrete choice experiment (DCE) was conducted to elicit preferences for living arrangements in dementia in urban and rural regions of Germany.
METHODS
METHODS
Preliminary work included review of previous literature and focus groups. The DCE consists of seven attributes (group size, staff qualifications, organization of care, activities offered, support of religious practice, access to garden, consideration of food preferences) with three levels each. Individuals from the general population between the ages of 50 and 65 years were identified through population registration offices in three rural municipalities and one urban area, and 4390 individuals were approached via postal survey. A hierarchical Bayesian mixed logit model was estimated and interactions with sociodemographic characteristics were investigated.
RESULTS
RESULTS
A total of 428 and 412 questionnaires were returned by rural and urban respondents, respectively. Access to a garden was perceived as the most important attribute (average importance 36.0% in the rural sample and 33.4% in the urban sample), followed by consideration of food preferences (15.8%, 17.8%), staff qualification (14.6%, 15.3%), care organization (11.4%, 12.3%), group size (12.2%, 11.1%), and range of activities (8.0%, 10.1%). The attribute relating to religious practice was given the least importance (2.1%, 0%). Preferences vary according to gender, age, religious beliefs, experience as an informal caregiver, and migrant background.
CONCLUSION
CONCLUSIONS
Heterogeneous preferences for living arrangements for people with dementia were identified. The expansion of concepts with access to natural environments for persons with dementia might be a viable option for the formal care market in Germany. Further research is needed to meet the challenges of setting up and designing innovative living arrangements for people with dementia. Preferences vary by gender, age, religious beliefs, experience as an informal caregiver, and migrant background.
Identifiants
pubmed: 37995011
doi: 10.1007/s41669-023-00452-9
pii: 10.1007/s41669-023-00452-9
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
© 2023. The Author(s).
Références
World Health Organization. Dementia. 2022. https://www.who.int/news-room/fact-sheets/detail/dementia . Accessed 29 Nov 2022.
GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7(2):e105–25. https://doi.org/10.1016/S2468-2667(21)00249-8 .
doi: 10.1016/S2468-2667(21)00249-8
World Health Organization. Global action plan on the public health response to dementia 2017–2025. 2017. https://www.who.int/publications/i/item/global-action-plan-on-the-public-health-response-to-dementia-2017---2025 . Accessed 29 Nov 2022.
Alzheimer’s Association. Stages of Alzheimer’s. https://www.alz.org/alzheimers-dementia/stages#:~:text=Alzheimer’s%20disease%20typically%20progresses%20slowly,progress%20through%20the%20stages%20%E2%80%94%20differently . Accessed 4 Oct 2023.
Matthews FE, Bennett H, Wittenberg R, Jagger C, Dening T, Brayne C. Who lives where and does it matter? Changes in the health profiles of older people living in long term care and the community over two decades in a high-income country. PLoS ONE. 2016;11(9): e0161705.
doi: 10.1371/journal.pone.0161705
pubmed: 27589586
pmcid: 5010384
Federal Ministry of Health. Leuchtturmprojekt Demenz. 2011. https://www.bundesgesundheitsministerium.de/service/publikationen/details/leuchtturmprojekt-demenz.html . Accessed 29 Nov 2022.
Moyle W. The promise of technology in the future of dementia care. Nat Rev Neurol. 2019;15(6):353–9.
doi: 10.1038/s41582-019-0188-y
pubmed: 31073242
Kok JS, Berg IJ, Scherder EJA. Special care units and traditional care in dementia: relationship with behavior, cognition, functional status and quality of life—a review. Dement Geriatr Cogn Disord Extra. 2013;3:360–75.
doi: 10.1159/000353441
Sharkey SS, Hudak S, Horn SD, James B, Howes J. Frontline caregiver daily practices: a comparison study of traditional nursing homes and the Green House project sites. J Am Geriatr Soc. 2011;59(1):126–31.
doi: 10.1111/j.1532-5415.2010.03209.x
pubmed: 21158746
Palm R, Bartholomeyczik S, Roes M, Holle B. Structural characteristics of specialised living units for people with dementia: a cross-sectional study in German nursing homes. Int J Ment Health Syst. 2014;8(1):39. https://doi.org/10.1186/1752-4458-8-39 .
doi: 10.1186/1752-4458-8-39
pubmed: 25360154
pmcid: 4213458
Kok JS, Nielen MMA, Scherder EJA. Quality of life in small-scaled homelike nursing homes: an 8-month controlled trial. Health Qual Life Outcomes. 2018;16(1):38. https://doi.org/10.1186/s12955-018-0853-7 .
doi: 10.1186/s12955-018-0853-7
pubmed: 29486788
pmcid: 5830070
Palm R, Holle B. Forschungsbericht der Studie DemenzMonitor. Veröffentlichungsreihe des Deutschen Zentrums für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten; 2016.
Wolf-Ostermann K, Worch A, Fischer T, Wulff I, Gräske J. Health outcomes and quality of life of residents of shared-housing arrangements compared to residents of special care units-results of the Berlin DeWeGE-study. J Clin Nurs. 2012;21(21–22):3047–60. https://doi.org/10.1111/j.1365-2702.2012.04305.x .
doi: 10.1111/j.1365-2702.2012.04305.x
pubmed: 23083386
Speckemeier C. Preferences for attributes of long-term care in dementia: a scoping review of multi-criteria decision analyses. J Public Health. 2023;31(10):1597–608. https://doi.org/10.1007/s10389-022-01743-x .
doi: 10.1007/s10389-022-01743-x
Statista. Prognostizierte Entwicklung der Anzahl von Demenzkranken im Vergleich zu den über 65-Jährigen in Deutschland bis 2050. 2023. Available at: https://de.statista.com/statistik/daten/studie/245519/umfrage/ . Accessed 29 Nov 2022.
Bartholomeyczik S, Halek M. Pflege-Report 2017 "Die Versorgung der Pflegebedürftigen“. Stuttgart: Schattauer; 2017.
Dudel C. Vorausberechnung des Pflegepotentials von erwachsenen Kindern für ihre pflegebedürftigen Eltern. Sozialer Fortschritt. 2015;64(1–2):14–24.
doi: 10.3790/sfo.64.1-2.14
Kohls M. Pflegebedürftigkeit und Nachfrage nach Pflegeleistungen von Migrantinnen und Migranten im demographischen Wandel. (Forschungsbericht / Bundesamt für Migration und Flüchtlinge (BAMF) Forschungszentrum Migration, Integration und Asyl (FZ), 12). Nürnberg: Bundesamt für Migration und Flüchtlinge (BAMF) Forschungszentrum Migration, Integration und Asyl (FZ) 2012.
BMFSFJ. Nationale Demenzstrategie. 2022. https://www.bmfsfj.de/bmfsfj/themen/aeltere-menschen/demenz/nationale-demenzstrategie . Accessed 29 Nov 2022.
Klie T, Heislbetz C, Schuhmacher B, Keilhauer A, Rischard P, Bruker C. Ambulant betreute Wohngruppen. Bestandserhebung, qualitative Einordnung und Handlungsempfehlungen. Abschlussbericht. AGP Sozialforschung und Hans-Weinberger-Akademie (Hrsg.). Berlin: Studie im Auftrag des Bundesministeriums für Gesundheit; 2017.
Klie T. Pflegereport 2018. Pflege vor Ort – gelingendes Leben mit Pflegebedürftigkeit. 2018. https://www.dak.de/dak/download/dak-pflegereport-2018-pdf-2126422.pdf . Accessed 29 Nov 2022.
Yu X, Bao H, Shi J, Yuan X, Qian L, Feng Z, Geng J. Preferences for healthcare services among hypertension patients in China: a discrete choice experiment. BMJ Open. 2021;11(12): e053270. https://doi.org/10.1136/bmjopen-2021-053270 .
doi: 10.1136/bmjopen-2021-053270
pubmed: 34876431
pmcid: 8655589
Wilberforce M, Challis D, Davies L, Kelly MP, Roberts C, Loynes N. Person-centredness in the care of older adults: a systematic review of questionnaire-based scales and their measurement properties. BMC Geriatr. 2016;16:63. https://doi.org/10.1186/s12877-016-0229-y .
doi: 10.1186/s12877-016-0229-y
pubmed: 26951641
pmcid: 4782329
Wijnen BF, van der Putten IM, Groothuis S, et al. Discrete-choice experiments versus rating scale exercises to evaluate the importance of attributes. Expert Rev Pharmacoecon Outcomes Res. 2015;15(4):721–8. https://doi.org/10.1586/14737167.2015.1033406 .
doi: 10.1586/14737167.2015.1033406
pubmed: 25835045
Clark MD, Determann D, Petrou S, Moro D, de Bekker-Grob EW. Discrete choice experiments in health economics: a review of the literature. Pharmacoeconomics. 2014;32(9):883–902. https://doi.org/10.1007/s40273-014-0170-x .
doi: 10.1007/s40273-014-0170-x
pubmed: 25005924
Soekhai V, Whichello C, Levitan B, et al. Methods for exploring and eliciting patient preferences in the medical product lifecycle: a literature review. Drug Discov Today. 2019;24(7):1324–31. https://doi.org/10.1016/j.drudis.2019.05.001 .
doi: 10.1016/j.drudis.2019.05.001
pubmed: 31077814
Lancsar E, Louviere J. Conducting discrete choice experiments to inform healthcare decision making: a user’s guide. Pharmacoeconomics. 2008;26(8):661–77. https://doi.org/10.2165/00019053-200826080-00004 .
doi: 10.2165/00019053-200826080-00004
pubmed: 18620460
Chester H, Clarkson P, Davies L, Sutcliffe C, Roe B, Hughes J, et al. A discrete choice experiment to explore carer preferences. Qual Ageing. 2017;18(1):33–43.
doi: 10.1108/QAOA-10-2015-0047
Chester H, Clarkson P, Davies L, Sutcliffe C, Davies S, Feast A, et al. People with dementia and carer preferences for home support services in early-stage dementia. Aging Ment Health. 2018;22(2):270–9.
doi: 10.1080/13607863.2016.1247424
pubmed: 27849124
Groenewoud S, Van Exel NJ, Bobinac A, Berg M, Huijsman R, Stolk EA. What influences patients’ decisions when choosing a health care provider? measuring preferences of patients with knee arthrosis, chronic depression, or Alzheimer’s disease, using discrete choice experiments. Health Serv Res. 2015;50(6):1941–72.
doi: 10.1111/1475-6773.12306
pubmed: 26768957
pmcid: 4693843
Jasper R, Chester H, Hughes J, Abendstern M, Loynes N, Sutcliffe C, et al. Practitioners preferences of care coordination for older people: a discrete choice experiment. J Gerontol Soc Work. 2018;61(2):151–70.
doi: 10.1080/01634372.2017.1417342
pubmed: 29252115
Kampanellou E, Chester H, Davies L, Davies S, Giebel C, Hughes J, et al. Carer preferences for home support services in later stage dementia. Aging Ment Health. 2019;23(1):60–8.
doi: 10.1080/13607863.2017.1394441
pubmed: 29090948
Nieboer AP, Koolman X, Stolk EA. Preferences for long-term care services: willingness to pay estimates derived from a discrete choice experiment. Soc Sci Med. 2010;70(9):1317–25.
doi: 10.1016/j.socscimed.2009.12.027
pubmed: 20167406
Sawamura K, Sano H, Nakanishi M. Japanese public long-term care insured: preferences for future long-term care facilities, including relocation, waiting times, and individualized care. J Am Med Dir Assoc. 2015;16(4):350.e9-20.
doi: 10.1016/j.jamda.2015.01.082
pubmed: 25732833
Teahan Á, Walsh S, Doherty E, O’Shea E. Supporting family carers of people with dementia: a discrete choice experiment of public preferences. Soc Sci Med. 2021;287: 114359.
doi: 10.1016/j.socscimed.2021.114359
pubmed: 34530220
Walsh S, O’Shea E, Pierse T, Kennelly B, Keogh F, Doherty E. Public preferences for home care services for people with dementia: a discrete choice experiment on personhood. Soc Sci Med. 2020;245: 112675.
doi: 10.1016/j.socscimed.2019.112675
pubmed: 31760321
Leibniz Science Campus Ruhr. https://lscr.rwi-essen.de/en/ , Accessed 20 Sept 2023.
Bridges JFP, Hauber AB, Marshall D, et al. Conjoint analysis applications in health–a checklist: a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force. Value Health. 2011;14(4):403–13. https://doi.org/10.1016/j.jval.2010.11.013 .
doi: 10.1016/j.jval.2010.11.013
pubmed: 21669364
World Health Organization. How to conduct a discrete choice experiment for health workforce recruitment and retention in remote and rural areas: a user guide with case studies. 2012. https://documents1.worldbank.org/curated/en/586321468156869931/pdf/NonAsciiFileName0.pdf . Accessed 6 Jun 2023.
Helter TM, Boehler CEH. Developing attributes for discrete choice experiments in health: a systematic literature review and case study of alcohol misuse interventions. J Subst Use. 2016;21(6):662–8. https://doi.org/10.3109/14659891.2015.1118563 .
doi: 10.3109/14659891.2015.1118563
pubmed: 27695386
pmcid: 5022136
Speckemeier C, Niemann A, Weitzel M, Abels C, Höfer K, Walendzik A, Wasem J, Neusser S. Assessment of innovative living and care arrangements for persons with dementia: a systematic review. BMC Geriatr. 2023;23(1):464.
doi: 10.1186/s12877-023-04187-4
pubmed: 37525120
pmcid: 10391868
Coast J, Al-Janabi H, Sutton EJ, Horrocks SA, Vosper AJ, Swancutt DR, Flynn TN. Using qualitative methods for attribute development for discrete choice experiments: issues and recommendations. Health Econ. 2012;21(6):730–41. https://doi.org/10.1002/hec.1739 .
doi: 10.1002/hec.1739
pubmed: 21557381
Kessels R, Jones B, Goos P. Bayesian optimal designs for discrete choice experiments with partial profiles. Journal of Choice Modelling. 2011;4(3):52–74. https://doi.org/10.1016/S1755-5345(13)70042-3 .
doi: 10.1016/S1755-5345(13)70042-3
Orme B. Sample size issues for conjoint analysis studies. Sequim: Sawtooth Software Technical Paper; 1998.
Johnson R, Orme B. Getting the most from CBC. Sequim: Sawtooth Software Research Paper Series, Sawtooth Software; 2003.
Hauber AB, González JM, Groothuis-Oudshoorn CGM, et al. Statistical methods for the analysis of discrete choice experiments: a report of the ISPOR Conjoint Analysis Good Research Practices Task Force. Value Health. 2016;19(4):300–15. https://doi.org/10.1016/j.jval.2016.04.004 .
doi: 10.1016/j.jval.2016.04.004
pubmed: 27325321
McFadden D. Conditional logit analysis of qualitative choice behavior. In: Zarembka P, editor. Frontiers in econometrics. New York: Academic Press; 1973.
Hensher DA, Rose JM, Greene WH. Applied choice analysis: a primer. Cambridge: Cambridge University Press; 2005.
doi: 10.1017/CBO9780511610356
Gamerman D. Sampling from the posterior distribution in generalized linear models. Stat Comput. 1997;7:57–68. https://doi.org/10.1023/A:1018509429360 .
doi: 10.1023/A:1018509429360
Hoedemakers M, Karimi M, Jonker M, Tsiachristas A, Rutten-van MM. Heterogeneity in preferences for outcomes of integrated care for persons with multiple chronic diseases: a latent class analysis of a discrete choice experiment. Qual Life Res. 2022;31(9):2775–89. https://doi.org/10.1007/s11136-022-03147-6 .
doi: 10.1007/s11136-022-03147-6
pubmed: 35585287
pmcid: 9356934
Hespanhol L, Sain Vallio CS, Menezes Costa LM, Saragiotto BT. Understanding and interpreting confidence and credible intervals around effect estimates. Braz J Phys Ther. 2019;23(4):290–301. https://doi.org/10.1016/j.bjpt.2018.12.006 .
doi: 10.1016/j.bjpt.2018.12.006
pubmed: 30638956
Larson E, Vail D, Mbaruku GM, Kimweri A, Freedman LP, Kruk ME. Moving toward patient-centered care in africa: a discrete choice experiment of preferences for delivery care among 3,003 Tanzanian women. PLoS ONE. 2015;10(8): e0135621. https://doi.org/10.1371/journal.pone.0135621 .
doi: 10.1371/journal.pone.0135621
pubmed: 26262840
pmcid: 4532509
Umar N, Quaife M, Exley J, Shuaibu A, Hill Z, Marchant T. Toward improving respectful maternity care: a discrete choice experiment with rural women in northeast Nigeria. BMJ Glob Health. 2020;5(3): e002135. https://doi.org/10.1136/bmjgh-2019-002135 .
doi: 10.1136/bmjgh-2019-002135
pubmed: 32201626
pmcid: 7059545
Milte R, Ratcliffe J, Chen G, Crotty M. What characteristics of nursing homes are most valued by consumers? A discrete choice experiment with residents and family members. Value Health. 2018;21(7):843–9. https://doi.org/10.1016/j.jval.2017.11.004 .
doi: 10.1016/j.jval.2017.11.004
pubmed: 30005757
Whear R, Coon JT, Bethel A, Abbott R, Stein K, Garside R. What is the impact of using outdoor spaces such as gardens on the physical and mental wellbeing of those with dementia? A systematic review of quantitative and qualitative evidence. J Am Med Dir Assoc. 2014;15(10):697–705. https://doi.org/10.1016/j.jamda.2014.05.013 .
doi: 10.1016/j.jamda.2014.05.013
pubmed: 25037168
Howarth DM, Brettle PA, Hardman DM, Maden M. What evidence is there to support the impact of gardens on health outcomes? Manchester: University of Salford; 2017. http://usir.salford.ac.uk/id/eprint/47230/ . Accessed 29 Nov 2022.
de Bruin SR, Pedersen I, Eriksen S, et al. Care farming for people with dementia; what can healthcare leaders learn from this innovative care concept? J Healthc Leadersh. 2020;12:11–8. https://doi.org/10.2147/JHL.S202988 .
doi: 10.2147/JHL.S202988
pubmed: 32210657
pmcid: 7071884
de Boer B, Hamers JPH, Zwakhalen SMG, et al. Green care farms as innovative nursing homes, promoting activities and social interaction for people with dementia. J Am Med Dir Assoc. 2017;18(1):40–6. https://doi.org/10.1016/j.jamda.2016.10.013 .
doi: 10.1016/j.jamda.2016.10.013
pubmed: 28012503
Graeske J, Nisius K, Renaud D. Bauernhöfe für Menschen mit Demenz – Ist-Analyse zu Verteilung und Strukturen in Deutschland. 2020. Available at: https://www.monitor-pflege.de/kurzfassungen/kurzfassungen-2020/mopf-02-2020-graeske . Accessed 29 Nov 2022.
Milte R, Ratcliffe J, Chen G, Miler M, Crotty M. Taste, choice and timing: Investigating resident and carer preferences for meals in aged care homes. Nurs Health Sci. 2018;20(1):116–24. https://doi.org/10.1111/nhs.12394 .
doi: 10.1111/nhs.12394
pubmed: 29314590
pmcid: 6635740
Lehnert T, Günther OH, Hajek A, Riedel-Heller SG, König HH. Preferences for home- and community-based long-term care services in Germany: a discrete choice experiment. Eur J Health Econ. 2018;19(9):1213–23. https://doi.org/10.1007/s10198-018-0968-0 .
doi: 10.1007/s10198-018-0968-0
pubmed: 29626266
Wilkins JM, Locascio JJ, Gomez-Isla T, Hyman B, Blacker D. Projection in proxy assessments of everyday preferences for persons with cognitive impairment. Am J Geriatr Psychiatry. 2023;31(4):254–63. https://doi.org/10.1016/j.jagp.2022.12.005 .
doi: 10.1016/j.jagp.2022.12.005
pubmed: 36609056
Cohen-Mansfield J, Gavendo R, Blackburn E. Activity Preferences of persons with dementia: An examination of reports by formal and informal caregivers. Dementia (London). 2019;18(6):2036–48. https://doi.org/10.1177/1471301217740716 .
doi: 10.1177/1471301217740716
pubmed: 29124947
Flynn TN, Louviere JJ, Peters TJ, Coast J. Best–worst scaling: what it can do for health care research and how to do it. J Health Econ. 2007;26(1):171–89. https://doi.org/10.1177/1471301217740716 .
doi: 10.1177/1471301217740716
pubmed: 16707175
Veldwijk J, Lambooij MS, de Bekker-Grob EW, Smit HA, de Wit GA. The effect of including an opt-out option in discrete choice experiments. PLoS ONE. 2014;9(11): e111805.
doi: 10.1371/journal.pone.0111805
pubmed: 25365169
pmcid: 4218820
Flynn TN, Bilger M, Malhotra C, Finkelstein EA. Are efficient designs used in discrete choice experiments too difficult for some respondents? A case study eliciting preferences for end-of-life care. Pharmacoeconomics. 2016;34(3):273–84. https://doi.org/10.1007/s40273-015-0338-z .
doi: 10.1007/s40273-015-0338-z
pubmed: 26589411
Quaife M, Terris-Prestholt F, Di Tanna GL, Vickerman P. How well do discrete choice experiments predict health choices? A systematic review and meta-analysis of external validity. Eur J Health Econ. 2018;19(8):1053–66. https://doi.org/10.1007/s10198-018-0954-6 .
doi: 10.1007/s10198-018-0954-6
pubmed: 29380229