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Slachevsky A, Grandi F, Thumala D, Baez S, Santamaria-García H, Schmitter-Edgecombe M, Parra MA. A Multidimensional, Person-Centered Framework for Functional Assessment in Dementia: Insights from the 'What', 'How', 'To Whom', and 'How Much' Questions. J Alzheimers Dis 2024; 99:1187-1205. [PMID: 38758997 PMCID: PMC11178450 DOI: 10.3233/jad-230376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Dementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.
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Affiliation(s)
- Andrea Slachevsky
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN) Neurology Department, Hospital del Salvador & Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – ICBM, Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Providencia, Santiago, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Fabrissio Grandi
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- School of Psychology, Universidad de los Andes, Santiago, Chile
| | - Daniela Thumala
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Psychology Department, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Sandra Baez
- Universidad de los Andes, Bogotá, Colombia
- Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Ireland
| | - Hernando Santamaria-García
- Pontificia Universidad Javeriana, PhD Program of Neuroscience, Bogotá, Colombia
- Center for Brain and Memory Intellectus. Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Maureen Schmitter-Edgecombe
- Herbert L. Eastlick Distinguished Professor in the Department of Psychology, Washington State University, Pullman, WA, USA
| | - Mario A. Parra
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Henderson J, Reid C. Virtual collaborative creative engagement in a pandemic world: creative connection for older adults with lived experience of dementia. FRONTIERS IN HEALTH SERVICES 2023; 3:1223337. [PMID: 38162191 PMCID: PMC10754963 DOI: 10.3389/frhs.2023.1223337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Introduction Older adults were disproportionately affected by COVID-19, and isolation and loneliness became key risk factors for mental illness and decreased quality of life. Older adults with lived experience of dementia and their care partners experienced isolation, loneliness, anxiety and depression, already heightened due to social stigma. Reduced access to resources was a notable problem. Objective This Canadian qualitative study investigates the Raising the Curtain on the Lived Experience of Dementia (RTC) Project's virtual turn in program delivery during the pandemic, asking "How did virtual collaborative creative engagement (CCE) impact well-being for people living with dementia and their care partners?"; and "What are key elements of RTC's unique virtual CCE approach?" Methods The study employs reflexive thematic analysis to analyse interviews and focus groups with the project's artist facilitators, researchers, peer collaborators living with dementia, and their care partners. Findings: Themes describe key elements of RTC's unique approach to virtual CCE and include: "Adjusting Expectations and Adapting to Technology"; "Re-imagining Creative Engagement in Virtual Space"; "Sustaining Reciprocal Caring, Learning, and Support"; "Disrupting Stigma and Welcoming a Wider Audience"; and "Supporting Well-being through Empowerment, Community, and Creativity." Discussion Findings offer new perspectives on how virtual CCE not only has the potential to decrease loneliness and isolation and associated mental health risks for older adults living with dementia and their care partners, but also can work to disrupt stigmatizing representations of dementia, promote inclusion, and enhance citizenship.
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Affiliation(s)
- Julia Henderson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Colleen Reid
- Department of Therapeutic Recreation, Douglas College, Coquitlam, BC, Canada
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Farhana N, Peckham A, Marani H, Roerig M, Marchildon G. The Social Construction of Dementia: Implications for Healthcare Experiences of Caregivers and People Living with Dementia. J Patient Exp 2023; 10:23743735231211066. [PMID: 38026064 PMCID: PMC10663651 DOI: 10.1177/23743735231211066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Globally, systems have invested in a variety of dementia care programs in response to the aging population and those who have been diagnosed with dementia. This study is a qualitative secondary analysis of interview data from a larger study investigating stakeholder perceptions of programs that support caregivers and people living with an Alzheimer's Disease or Alzheimer's Disease-related dementia (AD/ADRD) in five North American jurisdictions. This study analyzed interviews with individuals living with an AD/ADRD and caregivers of individuals living with an AD/ADRD (n = 11). Thematic analysis was conducted to understand how the perception of dementia may have shaped their engagement and experience with healthcare systems. Our analysis resulted in three main themes of care users' experience: (i) undesirable experience owing to the overarching negative shared understanding and stereotyping of dementia; (ii) dismissal throughout disease progression when seeking health and social care support; and (iii) dehumanization during care interactions. The findings carry critical social and clinical implications, for example, in informing person-centered approaches to care, and communication tools clinicians can use to enhance provider, patient, and caregiver well-being.
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Affiliation(s)
- Nusrat Farhana
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
| | - Allie Peckham
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, Arizona, USA
| | - Husayn Marani
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Monika Roerig
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Greg Marchildon
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Adkins-Jackson PB, George KM, Besser LM, Hyun J, Lamar M, Hill-Jarrett TG, Bubu OM, Flatt JD, Heyn PC, Cicero EC, Zarina Kraal A, Pushpalata Zanwar P, Peterson R, Kim B, Turner RW, Viswanathan J, Kulick ER, Zuelsdorff M, Stites SD, Arce Rentería M, Tsoy E, Seblova D, Ng TKS, Manly JJ, Babulal G. The structural and social determinants of Alzheimer's disease related dementias. Alzheimers Dement 2023; 19:3171-3185. [PMID: 37074203 PMCID: PMC10599200 DOI: 10.1002/alz.13027] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION The projected growth of Alzheimer's disease (AD) and AD-related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD. METHODS In this review, we employ Bronfenbrenner's ecological systems theory as a framework to posit how S/SDOH impact AD/ADRD risk and outcomes. RESULTS Bronfenbrenner defined the "macrosystem" as the realm of power (structural) systems that drive S/SDOH and that are the root cause of health disparities. These root causes have been discussed little to date in relation to AD/ADRD, and thus, macrosystem influences, such as racism, classism, sexism, and homophobia, are the emphasis in this paper. DISCUSSION Under Bronfenbrenner's macrosystem framework, we highlight key quantitative and qualitative studies linking S/SDOH with AD/ADRD, identify scientific gaps in the literature, and propose guidance for future research. HIGHLIGHTS Ecological systems theory links structural/social determinants to AD/ADRD. Structural/social determinants accrue and interact over the life course to impact AD/ADRD. Macrosystem is made up of societal norms, beliefs, values, and practices (e.g., laws). Most macro-level determinants have been understudied in the AD/ADRD literature.
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Affiliation(s)
- Paris B Adkins-Jackson
- Departments of Epidemiology & Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Kristen M George
- Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, California, USA
| | - Lilah M Besser
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jinshil Hyun
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, New York, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Tanisha G Hill-Jarrett
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Omonigho M Bubu
- Departments of Psychiatry, Population Health & Neurology, New York University Grossman School of Medicine, New York, New York, USA
| | - Jason D Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Nevada, USA
| | - Patricia C Heyn
- Center for Optimal Aging, Marymount University, Arlington, Virginia, USA
| | - Ethan C Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - A Zarina Kraal
- Department of Neurology, Columbia University, New York, New York, USA
| | - Preeti Pushpalata Zanwar
- Applied Health Economics & Outcomes Research & Health Policy, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- NIA Funded Network on Life Course and Health Dynamics and Disparities, University of Southern California, Los Angeles, California, USA
| | - Rachel Peterson
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Boeun Kim
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert W Turner
- Clinical Research & Leadership, Neurology, The George Washington University, Washington, D.C., USA
| | | | - Erin R Kulick
- MPH Department of Epidemiology and Biostatistics, Temple University, Philadelphia, Pennsylvania, USA
| | - Megan Zuelsdorff
- School of Nursing, Alzheimer's Disease Research Center, and School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Shana D Stites
- MA Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Miguel Arce Rentería
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
| | - Elena Tsoy
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Global Brain Health Institute, University of California San Francisco and Trinity College Dublin, San Francisco, California, USA
| | - Dominika Seblova
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ted K S Ng
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, Arizona, USA
| | - Jennifer J Manly
- Department of Neurology, Columbia University, New York, New York, USA
| | - Ganesh Babulal
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Institute of Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C., USA
- Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
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Creten S, Heynderickx P, Dieltjens S. The Stigma Toward Dementia on Twitter: A Sentiment Analysis of Dutch Language Tweets. JOURNAL OF HEALTH COMMUNICATION 2022; 27:697-705. [PMID: 36519829 DOI: 10.1080/10810730.2022.2149904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
People living with dementia are often faced with attitudes indicating stigma. Social media platforms, such as Twitter, can allow for self-expression and support, but can also be used to disseminate misinformation, which can reinforce existing stigma. In the present study, we explore whether the stigma toward dementia is present in Dutch language tweets. In total, 969 tweets containing dementia-related keywords were collected during a period of five months in 2019 and 2020. These were analyzed by means of a sentiment analysis, which we approached as a classification task. The tweets were coded into seven dimensions, i.e., information, joke, metaphor, organization, personal experience, politics, and ridicule, using a semi-automatic machine learning approach. The emerging correlations with our use of Linguistic Inquiry and Word Count software for sentiment analysis validate our approach. In the present study, 9.29% of tweets contain ridicule, propagating stigmatic attitudes on Twitter.
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Spencer L. Epistemic Injustice in Late-Stage Dementia: A Case for Non-Verbal Testimonial Injustice. SOCIAL EPISTEMOLOGY 2022; 37:62-79. [PMID: 36816431 PMCID: PMC9928428 DOI: 10.1080/02691728.2022.2103474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The literature on epistemic injustice has thus far confined the concept of testimonial injustice to speech expressions such as inquiring, discussing, deliberating, and, above all, telling. I propose that it is time to broaden the horizons of testimonial injustice to include a wider range of expressions. Controversially, the form of communication I have in mind is non-verbal expression. Non-verbal expression is a vital, though often overlooked, form of communication, particularly for people who have certain neurocognitive disorders. Dependency upon non-verbal expression is a common feature of some forms of neurocognitive disorders such as 'intellectual disabilities', autism and late-stage dementia. According to the narrow definition of testimonial injustice currently championed in the literature, people who express non-verbally are exempt from testimonial injustice. However, when we consider cases where meaningful communications from non-verbal people are dismissed or ignored in virtue of identity prejudice, there seems to be a distinct testimonial harm at play. Using late-stage dementia as a case study, I argue that the definition of testimonial injustice should be expanded to include all communicative practices, whether verbal or non-verbal, to encompass the epistemic harms inflicted upon some of the most marginalised in our society.
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Affiliation(s)
- Lucienne Spencer
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Oliveira D, Godoy C, da Mata FAF, Mateus E, Franzon ACA, Farina N, Evans-Lacko S, Ferri CP. Reducing dementia-related stigma and discrimination among community health workers in Brazil: protocol for a randomised controlled feasibility trial. BMJ Open 2022; 12:e060033. [PMID: 38687683 PMCID: PMC9301803 DOI: 10.1136/bmjopen-2021-060033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Stigma and discrimination among healthcare workers can hinder diagnosis and the provision of appropriate care in dementia. This study is aimed at developing, delivering and evaluating the feasibility of a group antistigma intervention to improve knowledge, attitudes and behaviours in relation to people living with dementia among community health workers (CHWs). METHODS AND ANALYSIS This will be a randomised controlled feasibility trial conducted with 150 CHWs from 14 primary care units (PCUs) in São Paulo, Brazil. PCUs will be randomly allocated (1:1) in two parallel groups-experimental group or control group. Participants from PCUs allocated to the experimental group will receive a 3-day group intervention involving audio-visual and printed materials as well as elements of social contact. The control group will keep their usual routine. Knowledge, attitude and intended behaviour stigma-based outcomes will be assessed at baseline and at follow-up (30 days after intervention) to both groups, with additional questions on feasibility for the experimental group at follow-up. Around 10-15 participants will take part in follow-up semistructured interviews to further explore feasibility. Quantitative analyses will follow an 'intention to treat' approach. Qualitative data will be analysed using content analysis. ETHICS AND DISSEMINATION This study was approved by the National Commission for Ethics in Research in Brazil (n. 5.510.113). Every participant will sign a consent form. Results will be disseminated through academic journals and events related to dementia. The intervention materials will be made available online.
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Affiliation(s)
- Déborah Oliveira
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Carolina Godoy
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Fabiana A F da Mata
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Elaine Mateus
- Brazilian Federation of Alzheimer's Associations (FEBRAZ), Paraná, Brazil
- Applied Linguistics, Department of Modern Languages, Universidade Estadual de Londrina (UEL), Paraná, Brazil
| | | | - Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Sara Evans-Lacko
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Cleusa P Ferri
- Department of Psychiatry, School of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
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Fair H, Klekociuk S, Eccleston C, Doherty K, Farrow M. Interpersonal Communication May Improve Equity in Dementia Risk Education. Health Promot J Austr 2022; 34:561-569. [PMID: 35355355 DOI: 10.1002/hpja.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED Encouraging people to adopt life-long habits that reduce dementia risk is necessary to manage the growing global prevalence of this condition and is, therefore, a global health priority. Current initiatives promoting risk-reducing behaviour primarily attract participants from a limited range of backgrounds, even if widely available. This may inadvertently increase health inequities, as the people who are most likely to develop dementia are the people who are least involved in risk-reduction initiatives. Interpersonal communication can effectively disseminate health messages to demographically diverse populations and may therefore broaden the reach of dementia risk reduction information. METHODS Coding reliability thematic analysis was used to categorise reports of information sharing provided by participants from one global online dementia risk education initiative, the [course - name removed for blinding]. These reports of information sharing were provided in response to the feedback question: "If you have already applied your [course] learning, please tell us how". RESULTS Information was reportedly shared with a wide range of people, including those from demographic groups that are under-represented among [course] participants. Information about specific risk factors was shared, along with general information about the course and/or dementia risk reduction. Some participants also reported that the people they shared information with were initiating risk-reducing behaviours. CONCLUSION Interpersonal communication has the potential to disseminate dementia risk reduction information to, and promote behaviour change among, a broad group of people at risk of dementia, thereby increasing equity in dementia risk education.
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Affiliation(s)
- Hannah Fair
- Wicking Dementia Research and Education Centre, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, Australia, 7000
| | - Shannon Klekociuk
- Wicking Dementia Research and Education Centre, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, Australia, 7000
| | - Claire Eccleston
- Wicking Dementia Research and Education Centre, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, Australia, 7000
| | - Kathleen Doherty
- Wicking Dementia Research and Education Centre, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, Australia, 7000
| | - Maree Farrow
- Wicking Dementia Research and Education Centre, University of Tasmania, 17 Liverpool St, Hobart, Tasmania, Australia, 7000
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9
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Abstract
Abstract
Having opportunities to make decisions and choices regarding one's life is crucial when living with dementia. This inter-disciplinary study draws on the concept of relational autonomy to explore how working-age people living dementia seek to influence their lives, and what makes it easier or more difficult for them in their everyday life. The data consist of three focus group discussions conducted with 12 retired adults who developed dementia while still employed. The results illuminate various resources that enable a person to (a) handle their difficulties at work and related consequences with dignity, (b) manage everyday tasks and live a fulfilling life, and (c) fight the stigma associated with (working-age) dementia. Challenges related to these aspects reported by the participants reveal gaps and obstacles that impede the full realisation of the rights of people living with early onset dementia. This research highlights the need for workplace education for different stakeholders, equal and ongoing access to guidance and counselling for younger people who live with dementia, and an effort by society as a whole to eradicate stigma.
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Werner P, Kim S. A Cross-National Study of Dementia Stigma Among the General Public in Israel and Australia. J Alzheimers Dis 2021; 83:103-110. [PMID: 34250936 PMCID: PMC8461698 DOI: 10.3233/jad-210277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite the increasing amount of research on dementia stigma, there is a dearth of cross-national studies conducted on this subject. This is surprising since the experience of stigma is closely associated to socio-cultural aspects. OBJECTIVE The present study intended to expand knowledge about the impact of culture on dementia stigma by comparing the level and correlates of stigmatic beliefs about dementia among the general public in Israel and Australia. METHODS A cross-sectional study using an online survey was conducted with two age-matched samples: 447 adults in Israel and 290 adults in Australia. RESULTS Overall, dementia stigma was moderate in both countries. However, the level of dementia stigma was significantly higher in Australia than in Israel. Lower levels of subjective knowledge and higher levels of ageism were associated with increased levels of stigmatic beliefs in both countries. Gender was a significant correlate of dementia stigma, with male participants reporting higher levels of public stigma than women, although this gender difference was mainly driven by the Australian sample. CONCLUSION Our findings indicate that providing knowledge and decreasing ageist attitudes should be key considerations in dementia awareness and stigma reduction campaigns despite the cultural context. In addition, developing gender-specific messages should be considered as a way of improving the effects of such campaigns.
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Affiliation(s)
- Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Sarang Kim
- Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, Australia
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11
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Harel D, Band-Winterstein T, Goldblatt H. Between sexual assault and compassion: The experience of living with a spouse's dementia-related hypersexuality-A narrative case-study. DEMENTIA 2021; 21:181-195. [PMID: 34269088 DOI: 10.1177/14713012211032068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypersexuality is one of the behavioral and psychological symptoms of dementia. This symptom can lead to poor quality of life for the person who lives with dementia, as well as for his or her caregiver, who might be exposed to sexual assault. AIM This study aimed to highlight the experience of an older woman living and coping with a spouse who exhibits dementia-related hypersexuality. METHOD A narrative case-study of a single case was designed, composed of four semi-structured interviews conducted over a 10-month period. The data were analyzed through thematic, structural, and performance analysis. FINDINGS Four phases were revealed, depicting the experience of being a partner and caregiver of a spouse with dementia-related hypersexuality: a) "I need help": A distress call; b) "It depends how long I agree to go on with it": Living with the ambiguous reality of dementia-related hypersexual behavior within an ongoing intimate relationship; c) "It's as if I'm hugging someone who's no longer alive": The transition from the previous couplehood identity to a new couplehood identity; and d) "I am just taking care of him as if he is a child": A compassionate couplehood identity construction. CONCLUSIONS Living with a partner with dementia-related hypersexuality is a distressing experience for the caregiver-spouse. Yet, positive memories from a long intimate relationship can lead to the creation of a compassionate identity, which supports the caregiving process, and creates a sense of acceptance and meaning making. This, in turn, enables a positive aging experience. These finding have some practical implications for supporting and intervening in such cases.
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Affiliation(s)
- Dovrat Harel
- The Graduate Program in Drama Therapy, 26748Tel Hai College, Upper Galilee, Israel
| | - Tova Band-Winterstein
- Department of Gerontology, Faculty of Social Welfare & Health Sciences, 26748University of Haifa, Haifa, Israel
| | - Hadass Goldblatt
- Department of Nursing, Faculty of Social Welfare & Health Sciences, 26748University of Haifa, Haifa, Israel
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Hosie A, Kochovska S, Ries N, Gilmore I, Parker D, Sinclair C, Sheehan C, Collier A, Caplan GA, Visser M, Xu X, Lobb E, Sheahan L, Brown L, Lee W, Sanderson CR, Amgarth-Duff I, Green A, Edwards L, Agar MR. Older Persons' and Their Caregivers' Perspectives and Experiences of Research Participation With Impaired Decision-Making Capacity: A Scoping Review. THE GERONTOLOGIST 2020; 62:e112-e122. [PMID: 32866239 DOI: 10.1093/geront/gnaa118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Human research ethics statements support equitable inclusion of diverse groups. Yet older people are under-represented in clinical research, especially those with impaired decision-making capacity. The aim of this study was to identify perspectives and experiences of older persons and their caregivers of research participation with impaired decision-making capacity. RESEARCH DESIGN AND METHODS Scoping review of literature and online sources in January-February 2019 (updated June 2020) according to Joanna Briggs Institute methodology and PRISMA Extension for Scoping Reviews. English-language peer-reviewed research articles and Australian online narratives were included. Data were tabulated and narratively synthesized. RESULTS From 4171 database records and 93 online resources, 22 articles (2000-2019, 82% United States, 16 first authors) and one YouTube webinar (2018) were initially included; updated searches yielded an additional article (2020) and YouTube webinar (2020). Studies were heterogeneous in terminology, methods and foci, with hypothetical scenarios, quantitative analyses and examination of proxy consent predominating. Participants (n=7331) were older persons (71%), caregivers of older persons with dementia/cognitive impairment (23%) and older persons with dementia/cognitive impairment (6%). Synthesis identified two themes: willingness to participate and decision-making approaches. DISCUSSION AND IMPLICATIONS Research participation by older persons with dementia may be optimized through reducing risks and burdens and increasing benefits for participants, greater consumer input into study development, and shared and supported decision-making. Older persons' and caregivers' perspectives and experiences of research participation with impaired decision-making capacity require investigation in a greater range of countries and conditions other than dementia, and dissemination through more varied media.
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Affiliation(s)
- Annmarie Hosie
- School of Nursing Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,The Cunningham Centre for Palliative Care, St Vincent's Health Network Sydney, Darlinghurst, New South Wales, Australia
| | - Slavica Kochovska
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Nola Ries
- Faculty of Law, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Imelda Gilmore
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Deborah Parker
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Craig Sinclair
- ARC Centre of Excellence in Population Ageing Research, University of New South Wales, Kensington, New South Wales, Australia
| | - Caitlin Sheehan
- Palliative Care Department, Calvary Health Care Kogarah, Kogarah, New South Wales Australia
| | - Aileen Collier
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Gideon A Caplan
- Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia.,Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mandy Visser
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia.,Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Xiaoyue Xu
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia.,Faculty of Medicine, School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Elizabeth Lobb
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia.,Palliative Care Department, Calvary Health Care Kogarah, Kogarah, New South Wales Australia
| | - Linda Sheahan
- South Eastern Sydney Local Health District, Clinical Ethics Service, Randwick, New South Wales, Australia.,Sydney Health Ethics, University of Sydney, Camperdown, New South Wales, Australia
| | - Linda Brown
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Wei Lee
- The Cunningham Centre for Palliative Care, St Vincent's Health Network Sydney, Darlinghurst, New South Wales, Australia.,Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Christine R Sanderson
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Ingrid Amgarth-Duff
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Anna Green
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Layla Edwards
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia
| | - Meera R Agar
- Faculty of Health, University of Technology Sydney, IMPACCT, Ultimo, New South Wales, Australia.,South West Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
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13
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Sari DW, Igarashi A, Takaoka M, Yamahana R, Noguchi-Watanabe M, Teramoto C, Yamamoto-Mitani N. Virtual reality program to develop dementia-friendly communities in Japan. Australas J Ageing 2020; 39:e352-e359. [PMID: 32483931 DOI: 10.1111/ajag.12797] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/10/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Dementia-friendly communities promote community coherence and reduce the risk of ageism in the community. This study examined the effects of a Virtual Reality (VR) educational program on participants' attitudes towards dementia and their sense of community related to supporting community-dwelling older adults. METHODS We delivered an educational program using a virtual reality platform that provided a first-person perspective of people with dementia in the courtyards of two convenience stores in the Tokyo Metropolitan Area, Japan. We investigated attitudes towards dementia and participants' sense of community before and after the educational program. RESULTS There were 42 study participants (average age = 48 years). The total scores of attitudes towards dementia and sense of community changed positively from pre- to postintervention (P = .004 and <.001, respectively). CONCLUSION This educational program for understanding dementia could enhance people's support of community members living with dementia.
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Affiliation(s)
- Dianis Wulan Sari
- Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Community and Gerontological Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Manami Takaoka
- Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Reiko Yamahana
- Department of Gerontological and Home-care Nursing, Chiba Faculty of Nursing, Tokyo Health Care University, Chiba, Japan
| | - Maiko Noguchi-Watanabe
- Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chie Teramoto
- Department of Community Health Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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14
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Leszko M. The role of online communication among spousal caregivers of individuals with Alzheimer's disease. J Women Aging 2020; 32:462-480. [PMID: 32302267 DOI: 10.1080/08952841.2020.1754119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study investigates (1) the importance of online communication for female caregivers (2) the impact of this form of maintaining social contact on well-being among 48 Polish spousal female caregivers of individuals with Alzheimer's disease. Data were collected using semi-structured interviews and self-completion questionnaires. Caregivers' online communication usage intensity was significantly associated with lower levels of depression and loneliness. Older women used online support groups to share their emotions related to the burden of providing care, to maintain a sense of social connection with other caregivers, and to access information about the disease. The results indicated Internet use has both positive and negative influences on the well-being of older women caregivers.
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Affiliation(s)
- Magdalena Leszko
- Department of Psychology, University of Szczecin , Szczecin, Poland
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15
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Syme ML, Cohn TJ. Elder sexual abuse and implicit agism: examining the warm-incompetent bias among mock jurors. J Elder Abuse Negl 2019; 32:1-26. [PMID: 31760911 DOI: 10.1080/08946566.2019.1695696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Implicit ageist beliefs about the warmth and incompetence of older adults may influence jurors' perceptions and judgments of an older adult's competence in legal cases hinging on capacity and consent, including elder sexual abuse. However, little is known about the nuances of implicit agism in elder sexual abuse cases, and if it can be attenuated. The current study proposed to address these gaps via a randomized vignette design administered to a community sample of 391 US adults. Mock juror participants evaluated an elder sexual abuse case involving an older married couple, in which the victim had dementia. Results suggest that implicit agism was present among mock jurors, consistent with a warm-incompetence bias, and was predictive of mock jurors' guilt ratings. Age- and dementia-relevant jury instructions and mock juror gender were not found to be predictive of guilt ratings. Implicit agism among jurors should be addressed to reduce the potential for implicit age bias to affect elder sexual abuse cases.
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Affiliation(s)
- Maggie L Syme
- Center on Aging, Kansas State University, Manhattan, New York, USA
| | - Tracy J Cohn
- Department of Psychology, Radford University, Radford, Virginia, USA
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16
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Evans SC, Atkinson T, Cameron A, Johnson EK, Smith R, Darton R, Porteus J, Lloyd L. Can extra care housing support the changing needs of older people living with dementia? DEMENTIA 2018; 19:1492-1508. [PMID: 30244597 DOI: 10.1177/1471301218801743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With over two-thirds of people with dementia living in the community and one-third of those living alone, it is important to consider the future housing needs of this population, particularly as symptoms of cognitive impairment increase. Policy in England has focused on enabling people living with dementia to remain in their own homes for as long as possible, often with the support of a family carer. However, many people struggle to maintain an acceptable quality of life in their own homes as their dementia advances, often due to the design limitations of mainstream housing and the challenge of finding specialist domiciliary care that is affordable and of sufficient quality. Extra care housing offers a model that aims to support older people living in their own apartments, whilst also offering specialist person-centred care as and when it is needed. This paper reports on a longitudinal project that explored how extra care housing can respond to the changing social care needs of residents, including those living with dementia. Participants included residents and staff from four extra care housing schemes, one of which was a specialist dementia scheme, in two regions of England. Interviews were carried with 51 residents across 4 rounds at 5 month intervals between October 2015 and June 2017. Interviews were also carried out with 7 managers, 20 care staff and 2 local authority commissioners of housing for older people. Key factors included person-centred care and support, flexible commissioning and staffing, appropriate design of the environment and suitable location of the scheme within the wider community. The challenge of delivering services that addresses these issues during a period of reduced public spending is acknowledged. Further research is suggested to compare different approaches to supporting people with dementia, including integrated and separated accommodation, and different stages of dementia.
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17
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Ben-David BM, Malkin G, Erel H. Ageism and Neuropsychological Tests. INTERNATIONAL PERSPECTIVES ON AGING 2018. [DOI: 10.1007/978-3-319-73820-8_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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