Family physicians' perceptions and predictors regarding the competence of a person with Alzheimer's disease

The influence of Alzheimer's disease stigma on pain assessment in older persons

INTRODUCTION

Pain of nursing homes residents with Alzheimer's disease remains under detected compared to their cognitively intact counterparts. Communication difficulties may partly explain this poor quality of care but the influence of stigmatization on pain assessment has never been explored.

RESEARCH QUESTION

The objective of this research was to analyze whether a diagnosis label of Alzheimer's disease or the stage of the disease may bias pain assessment scores and empathic reactions of health care staff in nursing homes.

METHODS

Two studies were conducted based on a similar experimental between-subjects design with a video showing an older adult woman experiencing undefined pain. Different labels and vignettes were manipulated to characterize the subject of the video. In the first study, 84 certified nursing assistants were asked to watch the video and then to assess the pain intensity and their empathic reaction. Participants were randomized in two conditions that varied the disease label (Alzheimer's disease vs no diagnosis). In the second study, 67 certified nursing assistants were enrolled who did not participate in the first study. They watched the same video as in the first study and assessed the pain intensity and their empathic reaction. They were randomized in two conditions that varied the stage of the Alzheimer's disease (mild stage vs severe stage).

RESULTS

Alzheimer's disease label had no influence on assessment scores. In contrast, the stage of the disease had a significant effect on the health care staff assessments with severe stage associated with lower pain intensity scores and empathic reactions.

CONCLUSION

These results confirm that the Alzheimer's disease stigma is a real phenomenon that tends to be mainly elicited by the symptoms of the acute phase of the disease. These findings are crucial to better understand the stigma related to Alzheimer's disease and to enhance the pain management of this frail population.

Value judgements and conceptual tensions: decision-making in relation to hospital discharge for people with dementia

We reflect, using a vignette, on conceptual tensions and the value judgements that lie behind difficult decisions about whether or not the older person with dementia should return home or move into long-term care following hospital admission. The paper seeks, first, to expose some of the difficulties arising from the assessment of residence capacity, particularly around the nature of evaluative judgements and conceptual tensions inherent in the legal approach to capacity. Secondly, we consider the assessment of best interests around place of residence, which demonstrates significant conceptual tensions. In addition, ‘best interests’ raise issues around the perception of risk and the perceptions of the family and crucially involve the notions of autonomy and trust. Finally, we not only gesture at some practical considerations based on insights from values-based medicine, but also make the suggestion that we require tighter functional assessments of residence capacity coupled with broader judgements about best interests.

Perceived Rights of and Social Distance to People with Alzheimer’s Disease

The present study investigated how laypeople and professionals (N = 185) judge the rights of someone affected with Alzheimer’s disease (AD) and whether social distance exists toward this person. Participants completed a questionnaire after reading a vignette describing a target person with an early stage of AD. Half of the participants responded to a female target, the other half to a male target. Results showed that the rights and competencies of the persons are rated high and social distance is exhibited only to a minor degree, although there was a significant difference between the male and female targets. Furthermore, health professionals approved more rights than laypeople, which suggests that there is a need for more detailed information about this disease in the general population.

The ambiguous relationships between aging and Alzheimer's disease: A critical literature review

One reason for the rise in the prevalence of Alzheimer's disease (AD) since the 1980s is the new association between the disease and aging. This paper explores the current representations of AD, questioning their relationships to aging, thanks to a literature review of 49 articles published in French and in English between 1995 and June 2010. Aging appears to be a concurrent diagnosis for AD, both for the lay public and for health professionals, but this confusion, which can be interpreted as a lack of medicalization of memory loss on the conceptual level, does not necessarily constitute an obstacle to medical intervention. The transformation of senile dementia into AD can diminish, as well as reinforce, stigmatization of people with AD. Moreover, elderly people with AD are subjected to both the persisting stigmas of aging and of dementia as well as, for most of them, that of feminine cognitive incompetence.

Who should make the decision on the use of GPS for people with dementia?

OBJECTIVES

In recent years advanced technologies, such as Global Positioning Systems (GPS), allow for tracking of human spatial activity and provide the ability to intervene to manage that activity. The purpose of this study is to examine the issue of who should decide about the use of electronic tracking using GPS for people with dementia.

METHODS

Based on quantitative data collected from 296 participants comprising cognitively intact elderly, family caregivers of people with dementia, social workers, other professionals, and social work students, study participants were asked to rate nine different potential decision-makers to make this decision.

RESULTS

The results show that figures inside the family, particularly the spouse or the most involved family caregiver, were perceived more important in the decision-making process than figures outside the family, whereas the person with dementia was ranked third in the order of the figures. Since the decision to use GPS for tracking raises the ethical dilemma of personal safety versus autonomy and privacy of people with dementia, the findings seem to indicate that the reluctance of professional caregivers to assist family caregivers to make this decision is experienced as frustrating.

CONCLUSIONS

The findings imply that in order to reach a balance between the wishes and interests of both people with dementia and their family caregivers, there is a need for more active involvement of the professional caregivers to facilitate the family decision-making process.