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Kong D, Romli MH, Devaraj NK, Sallehuddin H, Tan MP. A Meta-Synthesis on Sexuality in Persons with Dementia Mapped Using the Model of Human Occupation. Occup Ther Health Care 2024:1-31. [PMID: 38975945 DOI: 10.1080/07380577.2024.2375533] [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: 01/12/2024] [Accepted: 06/29/2024] [Indexed: 07/09/2024]
Abstract
Dementia affects the individual's functional ability including sexual activity. Limited understanding is available to support sexual health practices. This meta-synthesis review aimed to identify the gaps in the study of sexuality in dementia using the Model of Human Occupation (MOHO). Electronic searches utilizing six databases for existing articles involving persons living with dementia, care partners, and healthcare workers. The result showed that available studies primarily explored sexuality from the viewpoint of spouses of persons living with dementia. The volition domain of MOHO was the most explored provides a deeper understanding of volition on intrinsic perspective on sexuality in people with dementia. The environment domain was the least explored, highlighting healthcare professionals' need for social support and training. The topic of sexuality remains sensitive, limiting the availability of evidence-based interventions in this area.
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Affiliation(s)
- Dinnee Kong
- Genting Dementia Care Centre, Kuala Lumpur, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Hakimah Sallehuddin
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur
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Dunn R, Wolverson E, Hilton A. Exploring the interplay between dementia, multiple health conditions and couplehood: A qualitative evidence review and meta-ethnography. DEMENTIA 2024; 23:41-68. [PMID: 37969077 DOI: 10.1177/14713012231214017] [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: 11/17/2023]
Abstract
Background: On average, people with dementia live with 4.6 additional health conditions. Additionally, two thirds of carers of people with dementia are spouses, and are also likely to live with multimorbidity, given that older age is strongly associated with an increase in health conditions. Consequently, living with dementia and multimorbidity is often a shared experienced as a couple. However, research has not explored how living with both dementia and multimorbidity may impact on couplehood. Method: We conducted a qualitive evidence review using a meta-ethnographic approach, to answer the following question: In what way (if any) does living with dementia and multimorbidity impact on couplehood? No papers were found on couplehood, dementia and multimorbidity, therefore the review consists of a meta-synthesis of couples' experiences of living with dementia in relation to couplehood, with an additional search for any data related to health within the qualitative findings. Findings: Two major reciprocal themes and five subthemes were identified from the 14 study findings. 1. Change and adjustment in the relationship, which included themes around a sense of 'togetherness', change in roles and identity and developing shared coping strategies and 2. Commitment, which was encapsulated by themes on unconditional love and commitment to wedding vows. Health-related findings were limited but included the impact on emotional wellbeing and how other health conditions, rather than dementia, were attributed to a loss in physical sexual intimacy. Conclusion: This review found that couplehood was threatened when dementia symptoms progressed and couples experienced feelings of loss of independence and identity. However, a strong foundation of commitment, love and loyalty to each other developed over the course of the relationship, was the 'glue' that helped couples face dementia together. However, further research is needed to explore couples' experiences of living with both multimorbidity and dementia in relation to couplehood in order to develop holistic, relationship-centred interventions.
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Affiliation(s)
- Rosie Dunn
- School of Psychology and Social Work, Faculty of Health Sciences, University of Hull, UK
| | - Emma Wolverson
- School of Psychology and Social Work, Faculty of Health Sciences, University of Hull, UK
| | - Andrea Hilton
- School of Paramedical, PeriOperative and Advanced Practice, Faculty of Health Sciences, University of Hull, UK
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Nogueira MML, Neto JPS, Johannessen A, Dourado MCN. "Sexual activity for me is something else. It's the same as always: Sex aside and our love for each other." Changes in sexual activity in dementia from the view of spouse-carers'. J Aging Stud 2023; 67:101193. [PMID: 38012950 DOI: 10.1016/j.jaging.2023.101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 10/22/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
The study aimed to explore the impact of Alzheimer's disease (AD) on spouse-carer's lives and the ways it affects their marital relationship and sexual activity. Data were obtained from qualitative interviews conducted with 11 spouse-carers of people with AD. Using interpretative phenomenological analysis (IPA), three themes emerged: psychological and emotional impact, social impact, and sexual impact. Some spouse-carers reported stress, poor emotional well-being, frustration, doubts about how to deal with the situation, sadness, loneliness, perception of losing connection with the partner, and feelings of companionship disappearing. Meanwhile, other spouse-carers reported closer relations and greater affection for their care-recipients after the diagnosis. Changes in sexual activity were attributed to aging and/or the effects of the illness. Gender influenced the perception of changes in the marital relationship but not in sexual activity. Participants reported conflicting perspectives towards the importance of sexual activity in the marital relationship and the replacement of sexual intercourse with other modes of expressing affection. We believe that understanding the specificities of marital relationships of couples in whom one spouse was diagnosed with AD would be helpful for developing coping strategies for persons living with dementia and their spouses.
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Affiliation(s)
- Marcela Moreira Lima Nogueira
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Brazil.
| | | | - Aud Johannessen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway; Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
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Shen S, Liu H. Is Sex Good for Your Brain? A National Longitudinal Study on Sexuality and Cognitive Function among Older Adults in the United States. JOURNAL OF SEX RESEARCH 2023; 60:1345-1355. [PMID: 37506374 PMCID: PMC10615694 DOI: 10.1080/00224499.2023.2238257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Using a life course approach, we examined how sexuality is related to cognitive function for partnered older adults. We utilized longitudinal data from two rounds of the National Social Life, Health, and Aging Project (NSHAP) to analyze 1,683 respondents. Cognitive function was measured using a continuous Montreal Cognitive Assessment (MoCA) score. We considered both sexual frequency and sexual quality (i.e., physical pleasure, emotional satisfaction). We estimated cross-lagged models to consider the potential reciprocal relationship between sexuality and cognitive function. Results indicated that sexuality was not related to later cognitive function in the total sample, but the pattern varied by age and gender. For adults aged 62-74, better sexual quality (i.e., feelings of physical pleasure and emotional satisfaction) was related to better cognitive functioning, while for those aged 75-90, more frequent sex was related to better cognitive functioning. Feelings of physical pleasure were related to better cognitive functioning for men but not women. There was no evidence of cognitive functioning being related to later sexuality. The findings highlight the importance of age and gender in modifying the link between sexuality and cognition in later life.
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Affiliation(s)
- Shannon Shen
- Department of Sociology and Social Work, Hope College, Holland, Michigan, United States
| | - Hui Liu
- Center on Aging and the Life Course and Department of Sociology, Purdue University, West Lafayette, Indiana, United States
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Hochgraeber I, Köhler K, Stöcker H, Holle B. The dyadic relationship of family carers and people living with dementia - an umbrella review. Aging Ment Health 2023; 27:1965-1974. [PMID: 37390842 DOI: 10.1080/13607863.2023.2215191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/11/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVES The dyadic relationship of people living with dementia and their family carers is highly relevant when considering the stability of home-based care arrangements. There is a solid body of research that covers issues related to dyadic relationships. However, a synthesis of qualitative research is missing. Therefore, the aim of this review is to give an overview of the dyadic relationship, with the leading research question of what influences the dyadic relationship and how it can be maintained during the trajectory of the disease. METHODS We performed an umbrella review of qualitative literature on the basis of thematic synthesis and used the SoCA-Dem theory as a theoretical framework. Literature searches in the databases PubMed (MEDLINE), CINAHL, Scopus, and PsycInfo were performed from July to September 2020, additional papers were included until September 2022. We searched without timeframe restrictions and considered publications in English or German. RESULTS After a systematic database search, resulting in 1325 records, we included 12 reviews. Five analytical themes and 11 subthemes were identified. The analytical themes were 'change in the relationship', 'activities to maintain the relationship', 'continued togetherness', 'home as a place for enacting relationship', and 'influencing factors'. CONCLUSION The dyadic relationship is a complex and multifaceted phenomenon. It is characterized by family carers' attempts to continue togetherness using different strategies and is mainly influenced by the quality of the premorbid relationship and the mindset of the family carer.
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Affiliation(s)
- Iris Hochgraeber
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Kerstin Köhler
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Hannah Stöcker
- Faculty of Health, School of Psychology, Witten/Herdecke University, Witten, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
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Shen S, Liu H. Cognitive Impairment Leads to Increased Feelings of Sexual Obligation Among a National Longitudinal Sample of Sexually Active Adults Aged 62 and Older. THE GERONTOLOGIST 2023; 63:297-307. [PMID: 35675363 PMCID: PMC9960026 DOI: 10.1093/geront/gnac078] [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] [Received: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We work from a gendered life-course perspective to examine the relationship between cognitive impairment and feelings of sexual obligation among U.S. older adults. RESEARCH DESIGN AND METHODS Data are drawn from 2 rounds of the National Social Life, Health, and Aging Project (2010/2011 and 2015/2016). The analytic sample includes 575 sexually active respondents aged 62-86 at baseline. Cognitive impairment is measured using a survey-adapted version of the Montreal Cognitive Assessment, with categories of normal, mild cognitive impairment, and dementia. We estimate cross-lagged models to test the potential reciprocal relationships between cognitive impairment and feelings of sexual obligation. RESULTS Older adults with dementia at baseline had significantly higher odds of sexual obligation 5 years later than their peers with normal cognition at baseline, after adjusting for gender, race/ethnicity, education, income, age, marital status, self-rated health, depression, comorbidities, and sexual obligation at baseline. We find no evidence of a reciprocal relationship, as sexual obligation at baseline did not predict later cognitive status. DISCUSSION AND IMPLICATIONS Older adults with dementia often remain sexually active after their 60s, and many of them feel obligated to have sex with their partner. Our study highlights the importance of understanding the context of their sexual lives. The quality of their sexual relationship, such as whether they feel a duty to maintain their earlier sexual activity or please their partner, and the health implications of sexual obligation should be considered alongside the increase of older adults with dementia.
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Affiliation(s)
- Shannon Shen
- Department of Sociology, Texas A&M University-San Antonio, San Antonio, Texas, USA
| | - Hui Liu
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
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Albert SC, Eduardo Martinelli J, Costa Pessoa MS. Couples living with Alzheimer's disease talk about sex and intimacy: A phenomenological qualitative study. DEMENTIA 2023; 22:390-404. [PMID: 36594356 DOI: 10.1177/14713012221149759] [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: 01/04/2023]
Abstract
OBJECTIVES To obtain a deeper understanding of the phenomenon of sexuality within the couple relationship when one of the partners has received a diagnosis of Alzheimer's Disease. This study aimed to listen to the voices of both partners, and to investigate how their intimate relationship has been impacted by an Alzheimer's diagnosis. METHODS This study adopted a qualitative phenomenological approach, and the method used was Interpretative Phenomenological Analysis. The data was collected based on interviews with six couples, where one of the spouses had a mild to moderate Alzheimer's diagnosis. The interviews were recorded and transcribed, and a detailed analysis of each interview was performed. FINDINGS From the detailed analysis of the transcribed interviews, six main themes emerged: Sexual expression today; Alzheimer's and sexuality; desire to be a sexual being; different sexualities; sense of couplehood; and uncertain future. CONCLUSIONS The findings of this study provide a deeper insight into experiences of sexuality for couples living with Alzheimer's. Sexuality and intimacy of couples living with Alzheimer's continues to be an important aspect of the relationship, and in general, the partners wish to have the opportunity to express their sexuality. The construction of a sense of couplehood during the marriage tends to be a significant factor to sustain the changes that arise in the intimate relationship because of the diagnosis. However, despite the growing recognition of the existence and importance of sexuality in later life, persons with Alzheimer's have only recently starting to be recognized as sexual beings who wish to be heard.
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Affiliation(s)
- Susan Carol Albert
- Jundiai Medical University, Department of Health Sciences, 146840Faculdade de Medicina de Jundiaí, Jundiai, Brazil
| | - José Eduardo Martinelli
- Jundiai Medical University, Department of Health Sciences, 146840Faculdade de Medicina de Jundiaí, Jundiai, Brazil
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Stedje K, Kvamme TK, Johansson K, Stensæth KA, Odell-Miller H, Bukowska A, Tamplin J, Wosch T, Baker FA. Influential factors of spousal relationship quality in couples living with dementia - A narrative synthesis systematic review. DEMENTIA 2023; 22:281-302. [PMID: 36317673 PMCID: PMC9773007 DOI: 10.1177/14713012221137280] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM The aim of this systematic review is to identify factors that influence relationship quality in couples living with dementia. Previous research has shown how maintaining a positive spousal relationship quality is important for quality of life and coping for both the caregiver and the person with dementia. Knowledge of influential factors could contribute to a deeper understanding of the value of a couple-centred clinical practice and research, within the field of dementia. RESEARCH DESIGN AND METHODS Systematic procedures to database search, screening, data extraction and synthesis were followed. Qualitative, quantitative and mixed methods studies were included. A narrative synthesis was conducted through narrative summaries of included studies, thematic analysis and narrative descriptions of factors influencing relationship quality. RESULTS 39 studies were included in the study: 28 qualitative, 8 quantitative and 3 mixed methods. Through the narrative synthesis, 20 factors were identified. The factors were grouped into two overarching themes: The world of us and The world outside of us, and further to six influencing factor categories: (1) Attitudes and strategies, (2) Behaviour and activities, (3) Emotional connectedness, (4) Activities and experiences outside of the home, (5) Social behaviour and roles, and (6) Belonging and safety. DISCUSSION AND CONCLUSION The identified factors influence relationship quality in couples living with dementia on various levels. The findings of this review study should inform clinical, couple-centred dementia care practise and intervention studies, and further research should seek to gain deeper understandings of the individual factors and broader understandings of the correlations between factors.
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Affiliation(s)
- Kristi Stedje
- Kristi Stedje, Music therapy, Norwegian Academy of music, Slemdalsveien 11, Oslo 0363, Norway.
| | | | | | | | | | - Anna Bukowska
- 74803Akademia Wychowania Fizycznego im Bronislawa Czecha, Krakow, Poland
| | | | - Thomas Wosch
- 38954University of Applied Sciences Würzburg-Schweinfurt, Germany
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Colloby S, Whiting S, Warren A. Supporting the couple relationship following dementia diagnosis: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3643-e3655. [PMID: 36124618 PMCID: PMC10087355 DOI: 10.1111/hsc.14006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 08/09/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
There is now a significant body of research demonstrating the importance of supporting the couple's relationship for people living with dementia. Maintaining a strong relationship has been demonstrated to slow cognitive decline in dementia, reduce the caregiver's sense of burden and may delay the need for transfer into residential care. However, the potential for healthcare practitioners to deliver interventions to support the couple's relationship in the community remains largely unexplored. This scoping review aimed to locate interventions that support couples to maintain their relationship satisfaction when living with dementia. This review mapped studies across a broad range of disciplines and research methods, following the Joanna Brigg's Institute (JBI) framework. Following screening, 44 studies were identified. The approach of these programmes can be broadly grouped into three categories; Adaptation and use of shared activities to enhance the couple's relationship; Developing caregiver skills and reducing perceived burden to improve interaction and relationship quality; Connecting and strengthening the couple's relationship through sharing feelings and memories. Further research is required to explore the possibility and appropriateness of adaptation of these interventions for use by community healthcare practitioners. There is a need to identify interventions that can meet the needs of couples as dementia progresses into the moderate-severe stages. Heterogeneity and inconsistency in outcomes measurement for the couple's relationship, suggests the need to consider further how outcomes for couple's relationship quality may best be captured. It is also suggested that other existing programmes, outside of the scoping review results, but aimed at reducing dementia caregiver burden may have currently unexplored and developed outcomes for couple's relationship quality.
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Affiliation(s)
- Sarah Colloby
- Livewell SouthwestWest Therapy Team, Cumberland CentrePlymouthUK
- Faculty of Health, School of Health ProfessionsUniversity of Plymouth, Peninsula Allied Health CentrePlymouthUK
| | - Samantha Whiting
- Faculty of Health, School of Health ProfessionsUniversity of Plymouth, Peninsula Allied Health CentrePlymouthUK
| | - Alison Warren
- Faculty of Health, School of Health ProfessionsUniversity of Plymouth, Peninsula Allied Health CentrePlymouthUK
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Wawrziczny E, Picard S, Buquet A, Traversac E, Puisieux F, Pasquier F, Huvent-Grelle D, Doba K. Hypnosis Intervention for Couples Confronted with Alzheimer’s Disease: Promising Results of a First Exploratory Study. J Alzheimers Dis 2022; 89:1351-1366. [DOI: 10.3233/jad-220430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Dementia has a negative impact on the quality of life of the person with dementia and their spouse caregivers, as well as on the couple’s relationship, which can lead to high levels of distress for both partners. Hypnosis has been shown to be effective in managing distress and increasing the quality of the relationship. Objective: The aim was to develop a standardized hypnosis intervention for couples confronted with Alzheimer’s disease and evaluate its feasibility, acceptability, and helpfulness in managing the distress of both partners and increasing the quality of the relationship. Methods: In a single-arm study, sixteen couples received the 8-week intervention. Qualitative and quantitative assessments were conducted pre- and post-intervention as well as three months after. Results: 88.9% of couples (n = 16) of the final sample (n = 18) completed the intervention. Despite the negative representations of hypnosis, several factors led couples to accept to participate in this study: positive expectations, professional endorsement, medical application, non-drug approach, home-based, free, flexible, and couple-based intervention. The results showed a significant decrease in distress for both partners. These effects were maintained three months after the intervention. Couples felt more relaxed, had fewer negative emotions, accepted difficulties more easily, were more patient, and reported better communication and more affection in the relationship. Conclusion: Overall, this pilot study shows the feasibility and acceptability of hypnosis with couples confronted with Alzheimer’s disease. Although measures of the preliminary pre- and post-intervention effects are encouraging, confirmatory testing with a randomized controlled trial is needed.
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Affiliation(s)
- Emilie Wawrziczny
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
| | - Sandrine Picard
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
| | - Amandine Buquet
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
| | - Elodie Traversac
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
| | - François Puisieux
- Department of Geriatrics, Memory consultation, CHU Lille, Lille, France
| | - Florence Pasquier
- Department of Neurology, Memory Research and Resources Clinic, CHU Lille, Lille, France
| | | | - Karyn Doba
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
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Albert SC, Eduardo Martinelli J, Costa Pessoa MS. Dementia and its impacts on the intimate, sexual couple relationship: A systematic review of qualitative research studies. DEMENTIA 2022; 21:1449-1466. [PMID: 35142230 DOI: 10.1177/14713012211073205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE There is growing evidence for the need to recognize persons with dementia as sexual beings who wish to continue expressing their sexuality, including within their couple relationship. The aim of this literature review was to investigate empirical qualitative studies that examined sexuality and sexual intimacy in the couple relationship when one spouse has dementia. METHOD A systematic literature review was performed in January 2021, five data bases were searched: Pubmed, MedLine, Lilacs, Scopus, and SciELO. The references of articles included in the review were screened together with the references of other relevant reviews. RESULTS Nine studies were identified that investigated sexuality and sexual intimacy from the perspective of the couple living with dementia or from the perspective of the spouse. The analysis identified four key themes: addressing dementia and sexuality; challenges to maintaining sexuality within the couple relationship; forms of sexual expression; and the desire to be seen as a sexual being. CONCLUSION Despite evidence of the importance of sexuality in later life and the positive effects it has on the quality of the couple relationship, research has identified the difficulty of destigmatizing sexuality and older persons, particularly when considering couples affected by dementia. Further research is required to better understand how living with the illness impacts sexual expression and the intimacy of the couple relationship.
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Affiliation(s)
- Susan Carol Albert
- Department of Health Sciences, 146840Jundiai Medical University, (Faculdade de Medicina de Jundiaí) Jundiai, Brazil
| | - José Eduardo Martinelli
- Department of Health Sciences, 146840Jundiai Medical University, (Faculdade de Medicina de Jundiaí) Jundiai, Brazil
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Sandberg LJ, Rosqvist HB, Grigorovich A. Regulating, fostering and preserving: the production of sexual normates through cognitive ableism and cognitive othering. CULTURE, HEALTH & SEXUALITY 2021; 23:1421-1434. [PMID: 32772835 DOI: 10.1080/13691058.2020.1787519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
People with cognitive disabilities are commonly positioned as risky sexual subjects. This article discusses the discursive production of sexual normates in the form of desirable and normative able-minded sexual subjects, in scientific research on the sexuality and cognitive disabilities of younger and older individuals (in particular those with dementia). We identify three interrelated discourses: regulating sexuality; fostering sexuality; and preserving sexuality. The first of these, regulation, pathologises sexuality of people with cognitive disabilities as faulty and in need of restriction. The second discourse, fostering, is more affirmative and argues for educating for a 'healthy' sexuality of people with cognitive disabilities, to mitigate risks of abuse. This discourse is more salient with younger people. The third discourse, preservation, in contrast, is more visible with older people with dementia and affirms sexuality so long as it is consistent with a 'genuine' or 'authentic' sexuality of the past. In conclusion, scientific research reinforces the cultural ideal of the rational and autonomous individual (and as such the mature/adult) capable of making independent decisions and engaging in healthy, good sex, based on stable sexual identities. Findings demonstrate how age intersects with cognitive ableism to intensify the cultural anxiety that exists around the sexualities of people with cognitive disabilities.
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Affiliation(s)
- Linn J Sandberg
- School of Culture and Education, Södertörn University, Huddinge, Sweden
| | | | - Alisa Grigorovich
- The Kite Research Institute-UHN, University of Toronto, Toronto, Canada
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Navigating through incontinence: A qualitative systematic review and meta-aggregation of the experiences of family caregivers. Int J Nurs Stud 2021; 123:104062. [PMID: 34461378 DOI: 10.1016/j.ijnurstu.2021.104062] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/30/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Community dwelling older adults who are care dependent are highly affected by incontinence, resulting in substantial informal caregiver burden. Understanding the experiences of these caregivers is needed to develop supportive programs that reduce caregiver burden and rates of institutionalization for care recipients. OBJECTIVES This systematic review aimed to critically appraise and synthesize the qualitative literature on the perceptions, experiences, and consequences of informal caregivers managing incontinence in community dwelling older adults. DESIGN A qualitative evidence synthesis using meta-aggregation. DATA SOURCES CINAHL, Embase, Ovid Medline, PsycInfo, Scopus, and ProQuest Dissertations and Theses. REVIEW METHODS A comprehensive search was conducted to identify qualitative studies of all designs, published in English from January 1970 to November 2020, reporting on the experiences of unpaid adult family members or friends providing care at home to an adult aged 60 or older with urinary and/or fecal incontinence. Screening, data extraction, and quality appraisal were conducted independently by two reviewers, with disagreements resolved by consensus with all team members. Joanna Briggs Institute (JBI) processes were used to assess study quality, and the dependability and credibility of both study findings and synthesized findings. All articles included met predetermined criteria. RESULTS Database searches yielded 1165 references, of which 117 full-text documents were screened. Seven articles of moderate to high methodological quality met eligibility criteria and were included. Studies occurred in nine countries with 134 participants who were mostly female spouses of the care recipient. From these eligible studies, 49 findings were extracted with 35 equivocal or credible findings eligible for meta-aggregation. Findings were synthesized into the following four categories: 1) emotional responses, 2) physical, financial, and social consequences, 3) family roles and caregiver support, and 4) management and coping strategies. CONCLUSIONS Informal caregivers experience many physical, psychosocial, and financial challenges in caring for an older family member with incontinence. Educational and supportive programs for managing incontinence should be multi-component and tailored to meet the individual needs of informal caregivers. Future research should incorporate strategies to cope with emotional responses and offer practical strategies for managing incontinence. PROSPERO REGISTRATION CRD42017069185.
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Olfaction Is Associated With Sexual Motivation and Satisfaction in Older Men and Women. J Sex Med 2021; 18:295-302. [DOI: 10.1016/j.jsxm.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 01/17/2023]
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Gallagher EA, Stokes JE. Cognitive Functioning, Gender, and Marital Quality Among Older Married Couples: A Dyadic Approach. J Women Aging 2021; 33:137-152. [PMID: 33385305 DOI: 10.1080/08952841.2020.1852859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study examines associations of older husbands' and wives' cognitive functioning with both partners' marital quality. Generalized structural equation modeling analyzed data from 1,432 opposite-sex couples drawn from the 2016 wave of the Health and Retirement Study. Findings revealed that wives' poorer cognitive functioning was associated with wives reporting greater closeness and enjoyment of time with a spouse, whereas husbands' poorer cognitive functioning was associated with wives reporting greater marital strain, lower marital support, lower closeness, and less enjoyment of time with a spouse. This suggests that cognitive functioning has dyadic consequences for marital quality, which are highly gendered.
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Affiliation(s)
- Elizabeth A Gallagher
- Department of Gerontology, McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Jeffrey E Stokes
- Department of Gerontology, McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
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Sandberg LJ. Too late for love? Sexuality and intimacy in heterosexual couples living with an Alzheimer’s disease diagnosis. SEXUAL AND RELATIONSHIP THERAPY 2020. [DOI: 10.1080/14681994.2020.1750587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Linn J. Sandberg
- School of Culture and Education, Södertörn University, Huddinge, Sweden
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Chapman KR, Spitznagel MB. Measurement of sexual disinhibition in dementia: A systematic review. Int J Geriatr Psychiatry 2019; 34:1747-1757. [PMID: 31489715 DOI: 10.1002/gps.5208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/31/2019] [Indexed: 11/07/2022]
Abstract
Sexual disinhibition in dementia is correlated with multiple negative care recipient and caregiver outcomes but remains largely overlooked in the literature. Its prevalence is not well understood, with studies reporting between 1.8% and 25% presence of sexual disinhibition in dementia samples. One reason for the variability in the reported presence of sexual disinhibition may be lack of standardized methods for assessment. Several widely used measures for neuropsychiatric symptoms do not include items to assess sexual disinhibition. When measures do include sexual disinhibition, it is not addressed in a consistent manner. Inconsistency in how questions about sexual disinhibition are phrased is problematic, given that recent work shows it can differentially influence endorsement. Working toward a gold standard of sexual disinhibition measurement in dementia is needed. To this end, a systematic review of the literature to identify potentially appropriate instruments for measurement of sexual disinhibition in this population was conducted through the Web of Science and PubMed databases between January 2019 and February 2019. An overview of the 20 measures identified in this search is provided. Each measure is evaluated for appropriateness of use in dementia samples through broad examination of psychometric properties, structure, and format and the extent to which measure content overlaps with current conceptualizations of sexual disinhibition in dementia. Five common content domains were identified: hypersexuality, lewd/aberrant sexual behavior, inappropriate sexual advances, inappropriate sexual comments, and socially disruptive sexual behavior. No single measure addressed all content domains. Directions for future research are identified and discussed.
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Affiliation(s)
- Kimberly R Chapman
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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‘When it faded in her … it faded in me’: a qualitative study exploring the impact of care-giving on the experience of spousal intimacy for older male care-givers. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractOlder male care-givers play an increasingly important role in informal care-giving, yet they have received little attention in the literature. The aim of this study was to explore the impact of care-giving on the experience of spousal intimacy for older male care-givers. Twenty-four older male care-givers, drawn from a region of the United Kingdom, participated in one-to-one interviews about their care-giving role. Thematic analysis was used to analyse data, and the study was underpinned by theories of masculinity. Three main themes were identified: (a) ‘Impact of care-giving on the experience of sexual intimacy’; (b) ‘Impact of care-giving on the experience of emotional intimacy’; and (c) ‘Not up for discussion’. When sexual intimacy declined, some older male care-givers prioritised emotional intimacy; some struggled with the decline; and some were reluctant to discuss the issue. Additionally, some care-givers reported that they had not received support from external support providers for declining sexual or emotional intimacy. Intimacy has been highlighted as important for care-givers given its link with care-giver wellbeing and quality of life. Results of this study suggest that sexual and emotional intimacy was an issue for older male care-givers, and that this issue should be considered by external support providers as part of a holistic assessment of need in order to tailor effective support.
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McCormick SA, Vatter S, Carter LA, Smith SJ, Orgeta V, Poliakoff E, Silverdale MA, Raw J, Ahearn DJ, Taylor C, Rodda J, Abdel-Ghany T, Kwapong B, Leroi I. Parkinson's-adapted cognitive stimulation therapy: feasibility and acceptability in Lewy body spectrum disorders. J Neurol 2019; 266:1756-1770. [PMID: 31161388 PMCID: PMC6586694 DOI: 10.1007/s00415-019-09329-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/03/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Drug-based therapeutic approaches for Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) are moderately effective and not always tolerated. Tailoring psychosocial approaches in PDD and DLB may offer additional support and improve outcomes. We adapted home-based, care partner-delivered Cognitive Stimulation Therapy (CST) for individuals with PDD or DLB and their care partners (CST-PD). OBJECTIVES To evaluate the feasibility, acceptability, and tolerability of CST-PD. METHODS This randomised controlled trial used mixed methods, including a process evaluation. People with PDD, DLB or mild cognitive impairment in PD (PD-MCI) and their care partners were randomised to 12 weeks of treatment as usual (TAU) or CST-PD. Outcomes were feasibility of the study conduct (i.e., recruitment, retention rate) and acceptability and tolerability of the intervention. Measures included rating scales, researcher field notes, therapy diaries, and exploratory clinical and care partner efficacy measures. RESULTS The recruitment target was met with 76 consenting participant-dyads. Retention in both arms was high at over 70%. More than 90% of dyads undertook discrete sessions greater than 20 min duration, but the average number of sessions completed was lower than the recommended dose. Acceptability ratings (i.e., interest, motivation and sense of achievement) of the intervention were high. Participants reported no serious adverse events related to the intervention. CONCLUSIONS The field of psychosocial interventions for PDD and DLB is newly emerging, and we demonstrated that this type of intervention is acceptable and well tolerated. Evaluating its clinical effectiveness in a full-scale randomized controlled clinical trial is warranted. TRIAL REGISTRATION NUMBER The trial is a psychosocial intervention with an allocated ISRCTN number 11455062.
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Affiliation(s)
- Sheree A McCormick
- Division of Neuroscience and Experimental Psychology, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Sabina Vatter
- Division of Neuroscience and Experimental Psychology, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lesley-Anne Carter
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Sarah J Smith
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Ellen Poliakoff
- Division of Neuroscience and Experimental Psychology, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | | | - Jason Raw
- Pennine Acute Hospitals NHS Trust, Oldham, UK
| | - David J Ahearn
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Joanne Rodda
- North East London NHS Foundation Trust, London, UK
| | | | - Benjamin Kwapong
- Division of Neuroscience and Experimental Psychology, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Iracema Leroi
- Division of Neuroscience and Experimental Psychology, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
- Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland.
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Coping with Cognitive Impairment in People with Parkinson's Disease and Their Carers: A Qualitative Study. PARKINSONS DISEASE 2018; 2018:1362053. [PMID: 29850013 PMCID: PMC5911314 DOI: 10.1155/2018/1362053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/22/2018] [Indexed: 11/17/2022]
Abstract
Cognitive impairment is common in Parkinson's disease (PD). However, the psychosocial impact of living and coping with PD and cognitive impairment in people with PD and their carers have not been explored. This paper draws on a qualitative study that explores the subjective impact of cognitive impairment on people with PD and their carers. Thirty-six one-to-one interviews were completed; people with PD were from three groups: normal cognition, mild cognitive impairment, and dementia. Data collection and analysis were iterative, and verbatim transcripts were analysed using thematic analysis. Themes were interpreted in consultation with coping and adaptation theory. The analysis revealed four main themes: threats to identity and role, predeath grief and feelings of loss in carers, success and challenges to coping in people with PD, and problem-focused coping and finding meaning in caring. Our data highlight how cognitive impairment can threaten an individual's self-perception; the ostensible effects of cognitive impairment depended on the impact individual's perceived cognitive impairment had on their daily lives. For carers, cognitive impairment had a greater emotional impact than the physical symptoms of PD. The discussion that developed around protective factors provides possible opportunities for future interventions, such as psychological therapies to improve successful adjustment.
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Holdsworth K, McCabe M. The Impact of Dementia on Relationships, Intimacy, and Sexuality in Later Life Couples: An Integrative Qualitative Analysis of Existing Literature. Clin Gerontol 2018; 41:3-19. [PMID: 29161218 DOI: 10.1080/07317115.2017.1380102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The onset and progression of dementia can have a profound effect on the couple dyad. The aim of this systematic review was to analyze the literature investigating the impact of dementia on the relationships, intimacy, and sexuality in older couples. METHODS A systematic literature search was conducted in May 2016 for relevant research articles. Five databases were searched: Web of Science, PsycINFO, MedLine, Scopus and CINAHL. The reference lists of articles included in the review were screened along with the reference list of other relevant reviews. RESULTS Thirteen studies were identified that investigated relationships, intimacy, and sexuality from the perspective of the partner, the person with dementia or from the perspective of the couple jointly. The analysis revealed several themes including changes in responsibilities and roles, identity and self-esteem, affection, commitment, reciprocity, and sexual activity and satisfaction. CONCLUSION The results strongly suggest dementia has a significant impact on the couple relationship. There is a dearth of research involving the perspective of the person with dementia or the couple jointly. Future research should investigate the impact of dementia on relationships, intimacy, and sexuality from the perspective of partners, the person with dementia, and the couple jointly to ensure the development of appropriate information and services that meet the needs of both people in the couple relationship. CLINICAL IMPLICATIONS Clinicians should work closely with couples to develop tailored information and supports to assist couples in managing the multiple changes that occur in their relationship, intimacy, and sexuality due to dementia.
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Affiliation(s)
- Kristen Holdsworth
- a Institute for Health and Ageing , Australian Catholic University , Melbourne , Australia
| | - Marita McCabe
- a Institute for Health and Ageing , Australian Catholic University , Melbourne , Australia
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The impact of younger-onset dementia on relationships, intimacy, and sexuality in midlife couples: a systematic review. Int Psychogeriatr 2018; 30:15-29. [PMID: 28927483 DOI: 10.1017/s1041610217001806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of dementia on relationships, intimacy, and sexuality has been documented in later life couples. However, little is known about the experiences of couples living with younger-onset dementia. The aim of this systematic review was to analyze the literature describing the impact of younger-onset dementia on relationships, intimacy, and sexuality in midlife couples. METHODS A systematic literature search was conducted in July 2016 for relevant research papers. Five databases were searched: Web of Science, PsycINFO, MedLine, Scopus, and CINAHL. A quality appraisal checklist was used to assess the methodological quality of included studies. RESULTS Eleven studies were identified that explored relationships, intimacy, and sexuality from the perspective of the spouse, the person with dementia or both members of the dyad. Several themes were identified including shifts in roles and responsibilities, declines in relationship quality, changes in identity, and self-esteem, increasing social isolation and loneliness, shifts in intimacy, and changes in sexual activity. CONCLUSIONS Many of the reviewed studies were subject to a range of methodological issues including small sample sizes, small number of studies, and a reliance on the perspective of only one member of the dyad. Future research should follow couples longitudinally to gain a clearer picture of the impact of younger-onset dementia on the couple relationship over time. The inclusion of people living with younger-onset dementia in research will assist in developing a deeper understanding of the experiences of the individual and dyad.
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Intimacy and Sexuality in Institutionalized Dementia Care: Clinical-Ethical Considerations. HEALTH CARE ANALYSIS 2017; 25:52-71. [PMID: 25270505 DOI: 10.1007/s10728-014-0287-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Intimacy and sexuality expressed by nursing home residents with dementia remains an ethically sensitive issue for care facilities, nursing staff and family members. Dealing with residents' sexual longings and behaviour is extremely difficult, putting a burden on the caregivers as well as on the residents themselves and their relatives. The parties in question often do not know how to react when residents express themselves sexually. The overall aim of this article is to provide a number of clinical-ethical considerations addressing the following question: 'How can expressions of intimacy and sexuality by residents with dementia be dealt with in an ethically responsible way?' The considerations formulated are based on two cornerstones: (1) the current literature on older peoples' experiences regarding intimacy and sexuality after the onset of dementia, and (2) an anthropological-ethical framework addressing four fundamental pillars of human existence namely the decentred self, human embodiment, being-in-the-world and being-with-others. The resulting considerations are oriented toward the individual sphere, the partnership sphere, and the institutional sphere. The continuous interaction between these spheres leads to orientations that both empower the residents in question and respect the complex network of relationships that surrounds them.
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Roelofs TSM, Luijkx KG, Embregts PJCM. Love, Intimacy and Sexuality in Residential Dementia Care: A Spousal Perspective. DEMENTIA 2017; 18:936-950. [DOI: 10.1177/1471301217697467] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tineke SM Roelofs
- Schakelring, Waalwijk, the Netherlands; School of Social and Behavioral Sciences, Department of Tranzo, Tilburg University, Tilburg, the Netherlands
| | - Katrien G Luijkx
- School of Social and Behavioral Sciences, Department of Tranzo, Tilburg University, Tilburg, the Netherlands
| | - Petri JCM Embregts
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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Viaña JNM, Vickers JC, Cook MJ, Gilbert F. Currents of memory: recent progress, translational challenges, and ethical considerations in fornix deep brain stimulation trials for Alzheimer's disease. Neurobiol Aging 2017; 56:202-210. [PMID: 28385550 DOI: 10.1016/j.neurobiolaging.2017.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 02/08/2023]
Abstract
The serendipitous discovery of triggered autobiographical memories and eventual memory improvement in an obese patient who received fornix deep brain stimulation in 2008 paved the way for several phase I and phase II clinical trials focused on the safety and efficacy of this potential intervention for people with Alzheimer's disease. In this article, we summarize clinical trials and case reports on fornix deep brain stimulation for Alzheimer's disease and review experiments on animal models evaluating the physiological or behavioral effects of this intervention. Based on information from these reports and studies, we identify potential translational challenges of this approach and determine practical and ethical considerations for clinical trials, focusing on issues regarding selection criteria, trial design, and outcome evaluation. Based on initial results suggesting greater benefit for those with milder disease stage, we find it essential that participant expectations are carefully managed to avoid treatment disenchantment and/or frustration from participants and caregivers. Finally, we urge for collaboration between centers to establish proper clinical standards and to promote better trial results comparison.
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Affiliation(s)
- John Noel M Viaña
- Ethics, Policy & Public Engagement (EPPE) Program, Australian Research Council Centre of Excellence for Electromaterials Science, Hobart, Tasmania, Australia; Philosophy and Gender Studies Program, School of Humanities, Faculty of Arts and Law, University of Tasmania, Hobart, Tasmania, Australia.
| | - James C Vickers
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Mark J Cook
- Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Frederic Gilbert
- Ethics, Policy & Public Engagement (EPPE) Program, Australian Research Council Centre of Excellence for Electromaterials Science, Hobart, Tasmania, Australia; Philosophy and Gender Studies Program, School of Humanities, Faculty of Arts and Law, University of Tasmania, Hobart, Tasmania, Australia
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Wang CL, Shyu YIL, Wang JY, Lu CH. Progressive compensatory symbiosis: spouse caregiver experiences of caring for persons with dementia in Taiwan. Aging Ment Health 2017; 21:241-252. [PMID: 26362821 DOI: 10.1080/13607863.2015.1081148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Spouse caregivers have been the predominant family members who care for persons with dementia in Taiwan. Although studies in western countries have described the caregiving experiences and changes in the marital relationship for these spouse caregivers, this information is lacking in Taiwan. This study explored the experiences of spouse caregivers caring for persons with dementia in Taiwan. METHODS A grounded theory approach was used for this qualitative descriptive study. Data were collected through recorded in-depth interviews and observations with 15 spouse caregivers of persons with dementia. Constant comparative analysis was used to analyse the transcripts and field notes. RESULTS Analysis of interview transcripts revealed that the experiences of caregiving for spouse caregivers who lived with persons with dementia could be described as 'progressive compensatory symbiosis.' This core category included three components: awareness of unbalanced intimacy, making a commitment and implementing a compensatory scheme. These experiences could be either mutually beneficial or unbalanced and fluctuated as the disease progressed through the phases of 'subtle,' 'revealed' and 'confirmed,' which also influence the pace, transition and evolution of the compensatory symbiosis. CONCLUSION This exploratory study describes the family caregiving experiences for 15 spouse caregivers of persons with dementia in Taiwan. These results can provide guidance for developing interventions to prepare, facilitate and promote a mutually beneficial adjustment for spousal caregivers and their spouses as dementia progresses. The findings are worthy of further investigation with a larger sample and a prospective design.
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Affiliation(s)
- Ching-Lin Wang
- a School of Nursing, College of Medicine, Chang Gung University , Taoyuan City , Taiwan.,b Department of Nursing , Tzu Hui Institute of Technology , Pingtung County , Taiwan
| | - Yea-Ing Lotus Shyu
- a School of Nursing, College of Medicine, Chang Gung University , Taoyuan City , Taiwan.,c Healthy Aging Research Center , Chang Gung University , Taoyuan City , Taiwan
| | - Jing-Yun Wang
- d Department of Nursing , Yuh-Ing Junior College of Health Care & Management , Kaohsiung City , Taiwan
| | - Cheng-Hsien Lu
- e Department of Neurology , Chang Gung Memorial Hospital , Kaohsiung City , Taiwan
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Perception of change in sexual activity in Alzheimer's disease: views of people with dementia and their spouse-caregivers. Int Psychogeriatr 2017; 29:185-193. [PMID: 27719688 DOI: 10.1017/s1041610216001642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The onset of Alzheimer's disease (AD) affects couples' relationship. We investigated the perception of change and sexual satisfaction in spouse-caregivers and their partners diagnosed with AD. METHODS We compared 74 dyads of people with Alzheimer's disease (PwAD)/spouse-caregivers and 21 elderly dyads control. We assessed sexual satisfaction with Questionnaire on Sexual Experience and Satisfaction (QSES), cognition using a Mini-Mental State Examination (MMSE), disease severity using a Clinical Dementia Rating scale (CDR), awareness of disease with Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), functionality with Pfeffer Functional Activities Questionnaire (FAQ), depressive symptoms with Cornell Scale for Depression in Dementia (CSDD), quality of life using a Quality of Life in Alzheimer's Disease Scale (QoL-AD), and burden using a Zarit Burden Interview (ZBI). RESULTS We found differences between the perception and no perception of change in sexual activity of PwAD (p < 0.001), spouse-caregivers (p < 0.01), and controls (p < 0.05). Moderate to severe sexual dissatisfaction was observed in 36.5% of PwAD, 65% of spouse-caregivers, and 31% of controls. PwAD sexual satisfaction was related to cognitive impairment (p < 0.05). Spouse-caregivers sexual satisfaction was related to gender (p < 0.05) and the presence of sexual activity (p < 0.001). CONCLUSIONS The perception of change with higher sexual dissatisfaction, were significant in PwAD and their spouse-caregivers, in comparison with couples of elderly without dementia.
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Zokaei N, MacKellar C, Čepukaitytė G, Patai EZ, Nobre AC. Cognitive Training in the Elderly: Bottlenecks and New Avenues. J Cogn Neurosci 2016; 29:1473-1482. [PMID: 27897677 DOI: 10.1162/jocn_a_01080] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Development of measures to preserve cognitive function or even reverse cognitive decline in the ever-growing elderly population is the focus of many research and commercial efforts. One such measure gaining in popularity is the development of computer-based interventions that "exercise" cognitive functions. Computer-based cognitive training has the potential to be specific and flexible, accommodates feedback, and is highly accessible. As in most budding fields, there are still considerable inconsistencies across methodologies and results, as well as a lack of consensus on a comprehensive assessment protocol. We propose that the success of training-based therapeutics will rely on targeting specific cognitive functions, informed by comprehensive and sensitive batteries that can provide a "fingerprint" of an individual's abilities. Instead of expecting a panacea from training regimens, focused and personalized training interventions that accommodate individual differences should be developed to redress specific patterns of deficits in cognitive rehabilitation, both in healthy aging and in disease.
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Brotman S, Drummond J, Silverman M, Sussman T, Orzeck P, Barylak L, Wallach I, Billette V. Talking about Sexuality and Intimacy with Women Spousal Caregivers: Perspectives of Service Providers. HEALTH & SOCIAL WORK 2016; 41:263-270. [PMID: 29206976 DOI: 10.1093/hsw/hlw040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/14/2016] [Indexed: 06/07/2023]
Abstract
This article reports the findings of an exploratory study examining service provider perceptions and experiences of addressing sexuality and intimacy with women spousal caregivers. The caregiver-provider encounter is examined, and challenges faced by service providers in addressing sexuality are considered. Themes identified include ambivalence and discomfort, personal and institutional barriers, meanings attributed to sexuality and intimacy, and lack of opportunities to discuss experiences. Strategies to overcome silence and invisibility on the part of service providers in the health and social services system are considered.
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Affiliation(s)
- Shari Brotman
- School of Work, McGill University, 3506 University Street, Montreal, Quebec, Canada
| | | | | | | | - Pam Orzeck
- Leading Practices in Caregiving, CIUSSS West-Central Montreal Health/CLSC René Cassin Centre for Research and Expertise in Social Gerontology
| | - Lucy Barylak
- Leading Practices in Social Gerontology, CIUSSS West-Central Montreal Health/CLSC René Cassin Centre for Research and Expertise in Social Gerontology
| | | | - Veronique Billette
- Equipe VIES, Institut national de la recherche scientifique, INRS Urbanisation Culture Société, Quebec, Montreal
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Wawrziczny E, Berna G, Ducharme F, Kergoat MJ, Pasquier F, Antoine P. Modeling the Distress of Spousal Caregivers of People with Dementia. J Alzheimers Dis 2016; 55:703-716. [DOI: 10.3233/jad-160558] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Emilie Wawrziczny
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
- Roubaix Hospital, Addiction Service, Roubaix, France
| | - Guillaume Berna
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
| | - Francine Ducharme
- Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
- Université de Montréal, Montréal, QC, Canada
| | - Marie-Jeanne Kergoat
- Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
- Université de Montréal, Montréal, QC, Canada
| | - Florence Pasquier
- Department of Neurology, Memory Research and Resources Clinic at the University Hospital of Lille, Lille, France
| | - Pascal Antoine
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
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Spouses' experience of living with a partner diagnosed with a dementia: a synthesis of the qualitative research. Int Psychogeriatr 2016; 28:537-56. [PMID: 26750862 DOI: 10.1017/s1041610215002239] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The majority of people diagnosed with a dementia live at home with the support of their spouse. While this situation has advantages, it brings many challenges for the spouse, particularly dealing with the emotional impact of the behavioral changes associated with the dementia. A growing body of qualitative research has focused on understanding the spousal caregiver perspective of living with a partner diagnosed with dementia. The aim of this study was to complete a synthesis of the results of published qualitative studies that have explored the spousal experience. METHOD An electronic database search of Ovid Medline, CINAHL, EMBASE, and PsychINFO from January 1980 to September 2014 was conducted. Sixteen studies met the inclusion criteria. Verbatim quotes of the participant interview data derived from these studies were collated and a thematic analysis was conducted. RESULTS Synthesis of the published data revealed five major themes. The theme of "loss of partner" was central, and around this central experience spouses described various processes: acknowledging change, being in crisis, adapting and adjusting, accepting and moving forward. CONCLUSIONS These findings provide insights into the day-to-day adjustments and experiences of spousal caregivers whilst highlighting the importance of considering the impact of cognitive decline and dementia in a social-relational context.
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Välimäki TH, Martikainen JA, Hongisto K, Väätäinen S, Sintonen H, Koivisto AM. Impact of Alzheimer’s disease on the family caregiver’s long-term quality of life: results from an ALSOVA follow-up study. Qual Life Res 2015; 25:687-97. [DOI: 10.1007/s11136-015-1100-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 10/23/2022]
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Wilkins JM. More Than Capacity: Alternatives for Sexual Decision Making for Individuals With Dementia. THE GERONTOLOGIST 2015; 55:716-23. [DOI: 10.1093/geront/gnv098] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/28/2015] [Indexed: 11/13/2022] Open
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Gomersall T, Astell A, Nygård L, Sixsmith A, Mihailidis A, Hwang A. Living With Ambiguity: A Metasynthesis of Qualitative Research on Mild Cognitive Impairment. THE GERONTOLOGIST 2015; 55:892-912. [PMID: 26315317 PMCID: PMC4580312 DOI: 10.1093/geront/gnv067] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/17/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose of the study: Mild Cognitive Impairment (MCI) is a diagnosis proposed to describe an intermediate state between normal cognitive aging and dementia. MCI has been criticised for its conceptual fuzziness, its ambiguous relationship to dementia, and the tension it creates between medical and sociological understandings of “normal aging”. Design and Methods: We examined the published qualitative literature on experiences of being diagnosed and living with MCI using metasynthesis as the methodological framework. Results: Two overarching conceptual themes were developed. The first, MCI and myself-in-time, showed that a diagnosis of MCI could profoundly affect a person’s understanding of their place in the world. This impact appears to be mediated by multiple factors including a person’s social support networks, which daily activities are affected, and subjective interpretations of the meaning of MCI. The second theme, Living with Ambiguity, describes the difficulties people experienced in making sense of their diagnosis. Uncertainty arose, in part, from lack of clarity and consistency in the information received by people with MCI, including whether they are even told MCI is the diagnosis. Implications: We conclude by suggesting an ethical tension is always at play when a MCI diagnosis is made. Specifically, earlier support and services afforded by a diagnosis may come at the expense of a person’s anxiety about the future, with continued uncertainty about how his or her concerns and needs can be addressed.
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Affiliation(s)
- Tim Gomersall
- School of Health & Related Research, University of Sheffield, Sheffield, UK.
| | - Arlene Astell
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Louise Nygård
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Andrew Sixsmith
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Alex Mihailidis
- Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada
| | - Amy Hwang
- Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada
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Abstract
BACKGROUND The relationship between sexuality and quality of life (QoL) of spouse-caregivers remains unclear. We designed this study to evaluate the relationship between sexual satisfaction and spouse-caregivers' QoL, and to determine the influence of the clinical characteristics of people with dementia (PWD) on spouse-caregivers' self-reported QoL. METHODS Using a cross-sectional design, 54 PWD and their spouse-caregivers completed the QoL in Alzheimer's Disease scale (QoL-AD), questionnaire on sexual experience and satisfaction (QSES), Mini-Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR), Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), Pfeffer functional activities questionnaire (FAQ), the Cornell scale for depression in dementia (CSDD) and Zarit burden interview (ZBI). Univariate and multivariate regression analyses were conducted to identify the factors that influenced the spouse-caregivers' QoL ratings. RESULTS We did not find a significant difference in QoL between male and female spouse-caregivers (p = 0.71). We also found that 13% of males and 48.1% of females demonstrated moderate to severe sexual dissatisfaction. However, we did not find a significant correlation between spouse-caregivers' QoL and sexual satisfaction (p = 0.41). The linear regression indicated that impaired awareness and lower QoL of PWD were significantly related to spouse-caregivers' QoL (p = 0.000). CONCLUSIONS The spouse-caregivers' QoL is influenced by awareness of disease and PWD QoL. Our study would be helpful for the development of adequate psycho-educational approaches to increase spouse-caregivers' QoL, considering the specificities of the couples' relationship.
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Foley S. Biopsychosocial Assessment and Treatment of Sexual Problems in Older Age. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-015-0047-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
ABSTRACTThe purpose of this study is to develop and extend our understanding of dementia care-giving by introducing a typology of informal care-giving across four different diseases. Care-giving factors were examined with respect to specific dementia presentation in mild cognitive impairment, Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease-associated dementia. Informal care-giving literature in the four diseases was systematically searched to identify specific disease symptoms and resultant care-giving strains and outcomes. Key concepts were extracted and grouped thematically. The first classification, ‘role-shift’, reflects care-giving where cognitive deterioration results in changing roles, uncertainty and relational deprivation among married partners. The second classification, ‘consumed by care-giving’, refers to those caring for persons with dementia-motor decline that greatly increases worry and isolation. Finally, in the ‘service use’ classification, formal support is needed to help care-givers cope with daily responsibilities and behaviour changes. In each case, the dementia presentation uniquely impacts care-giver strains. A major conclusion is that the same support to all care-givers under the umbrella term ‘dementia’ is unwarranted; the development of targeted support is required.
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Ghosh S, Libon D, Lippa C. Mild Cognitive Impairment: A Brief Review and Suggested Clinical Algorithm. Am J Alzheimers Dis Other Demen 2014; 29:293-302. [PMID: 24370618 PMCID: PMC10852630 DOI: 10.1177/1533317513517040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mild cognitive impairment (MCI) is a dynamic state between normal cognition and dementia, where interventions can be taken to stop or delay the progression to dementia. It is broadly of 2 types-amnestic, where memory loss is the chief concern and nonamnestic, where it is not. One variant of nonamnestic, dysexecutive, being more prevalent is sometimes known as a separate subtype by itself. Diagnosis of MCI is mostly clinical and is aided by various scales and neuropsychological testing. Functional imaging studies help in early detection and is superior to biomarkers or structural magnetic resonance imaging. Although there is no evidence supporting any pharmacological intervention, cognitive rehabilitation, memory training, and caregiver support play a strong role in limiting and sometimes reversing the ongoing cognitive decline. As the spectrum of MCI is heterogeneous, making the right diagnosis can be a challenging; hence, we need a systematic yet cost-effective algorithm for the timely management of MCI.
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Affiliation(s)
- Sayantani Ghosh
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - David Libon
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Carol Lippa
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
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Momtaz YA, Hamid TA, Ibrahim R. The impact of mild cognitive impairment on sexual activity. Am J Alzheimers Dis Other Demen 2013; 28:759-62. [PMID: 24085247 PMCID: PMC10852860 DOI: 10.1177/1533317513504612] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVE The aim of this study was to identify the unique impact of mild cognitive impairment (MCI) on sexual activity among older adults. METHODS Data for the study were drawn from a national survey entitled the "Determinants of Wellness among Older Malaysians: A Health Promotion Perspective" conducted in 2010. RESULTS According to the Mini-Mental State Examination education-adjusted cutoff points, 15.6% of the 1046 respondents were identified as having MCI. Older adults with MCI had a significantly lower level of sexual activity than the healthy cognitive group (chi-square = 50.20, P < .001, 32.5% vs 62.3%). The results of 3-step hierarchical logistic regression model revealed that MCI is significantly associated with decreased sexual activity in community-dwelling older adults, over and beyond demographic factors, and age-related medical conditions affecting sexual activity (odds ratio 0.33, P < .001, 95% confidence interval 0.23-0.49). CONCLUSION Findings from the present study support the significant role of cognitive functioning to perform sexual activity in later life.
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Affiliation(s)
| | - Tengku Aizan Hamid
- Institute of Gerontology, Social Gerontology Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rahimah Ibrahim
- Institute of Gerontology, Social Gerontology Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Wood H, Cupitt C, Lavender T. The Experience of Cognitive Impairment in People with Psychosis. Clin Psychol Psychother 2013; 22:193-207. [PMID: 24281753 DOI: 10.1002/cpp.1878] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 09/21/2013] [Accepted: 10/21/2013] [Indexed: 11/10/2022]
Abstract
Cognitive impairment has been widely studied in people with psychosis. However, research is lacking into the subjective experience of cognitive impairment, its impact and ways in which individuals cope. This study aimed to provide an account of the experience of cognitive impairment in people with a diagnosis of schizophrenia, including what difficulties people experience, how these difficulties are understood, how people respond to these difficulties and how they perceive others' views of these difficulties. A semi-structured interview was carried out with eight participants with a diagnosis of schizophrenia focusing on participants' experiences of difficulties with cognitive functioning. Interpretative phenomenological analysis was used to analyse interview transcripts. Experience of cognitive impairment was understood in terms of six master themes: impaired controlled thinking, physical sensations and impaired movement, explanations for the impairment and comparisons to the past, managing the impairment, how others see the impairment and anticipating the future. This study is the first rigorous qualitative study of the subjective experience of cognitive impairment in people with psychosis, and it provides greater context for empirical findings. The results have significant implications for clinical psychology, including education about cognitive difficulties and the importance of cognitive functioning to formulation. New areas for research include coping strategies in relation to functioning and future perspectives, ascertaining staff understanding of cognitive impairment, and reflective conversation style as an intervention for metacognitive difficulties. Key Practitioner Message Difficulties with cognitive functioning should be considered in clinical practitioners' formulations of clients' difficulties in the context of psychosis. Services should consider providing service user and carer education about cognitive impairment in psychosis. Staff may need further training in order to support people with psychosis who have difficulties with cognitive functioning.
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Affiliation(s)
- Helen Wood
- Canterbury Christ Church University, Applied Psychology, Tunbridge Wells, UK
| | - Caroline Cupitt
- Bexley Assertive Outreach Team, Oxleas NHS Foundation Trust, Erith, UK
| | - Tony Lavender
- Canterbury Christ Church University, Applied Psychology, Tunbridge Wells, UK
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Abstract
PURPOSE OF REVIEW The review assesses recent research and its impact on understanding of intimacy and sexuality in older adults with dementia. RECENT FINDINGS There is no universally accepted definition of inappropriate sexual behaviors (ISBs), but they have been divided into overt acts associated with increased libido and uninhibited sexual behaviors directed at oneself or other people. Couples affected by dementia frequently maintain physical intimacy. Nonintercourse intimate activities may be preferred over intercourse. Early therapeutic interventions may assist partners in modifying activities, behaviors, and expectations about the future of the relationship. Inappropriate sexual behaviors are commonly due to the disruption of interconnected brain structures. Trauma to the temporal lobes may lead to hypersexuality and ISB. Trauma to the limbic system can produce changes in sexual preference. Both temporal and frontotemporal dementias, or either of them, often present with socially and sexually inappropriate behaviors. Huntington's disease can exhibit hypersexuality, pedophilia, promiscuity, and marital infidelity. The involvement of the medial striatum of the basal ganglia in this disease explains the prevalence of ISB. There is no consensus regarding first-line pharmacotherapy for ISB. Little information is known about the adverse effects. SUMMARY Clinicians and society need to consider how dementia might affect physical intimacy.
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Pasymowski S, Roberto KA, Blieszner R. Adjustment to Mild Cognitive Impairment: Perspectives of Male Care Partners and Their Spouses. JOURNAL OF COUPLE & RELATIONSHIP THERAPY-INNOVATIONS IN CLINICAL AND EDUCATIONAL INTERVENTIONS 2013. [DOI: 10.1080/15332691.2013.806703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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de Vugt ME, Verhey FRJ. The impact of early dementia diagnosis and intervention on informal caregivers. Prog Neurobiol 2013; 110:54-62. [PMID: 23689068 DOI: 10.1016/j.pneurobio.2013.04.005] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 03/27/2013] [Accepted: 04/04/2013] [Indexed: 11/17/2022]
Abstract
In the absence of disease modifying therapies for dementia, the question rises what the benefits are of an early dementia diagnosis for patients and their caregivers. This paper reviews the caregiver perspective in dementia and addresses the question what the consequences are of promoting earlier dementia diagnosis. An early diagnosis offers caregivers the opportunity to advance the process of adaptation to the caregiver role. Caregivers that are better able to adapt to the changes that characterize dementia, feel more competent to care and experience less psychological problems. However, drawbacks of an early diagnosis may outweigh the benefits if people are left with a diagnosis but little support. There is convincing evidence that multicomponent caregiver interventions in the mild to moderate dementia stages are effective to improve caregiver well-being and delay institutionalization. However, there still exist a gap between the improved possibilities to diagnose people in the predementia stage versus the scarce knowledge on intervention effects in this very early stage. This stresses the urgent need for more research on early caregiver interventions that enhance role adaptation and that include long-term follow-up and cost-effectiveness evaluation. Early interventions may help caregivers in anticipating and accepting the future care role and transitions, with the increased possibility that caregivers can still involve the patient in the decision making process. As levels of stress and burden are still low in the predementia stage it provides excellent opportunities to empower the resources of caregivers.
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Affiliation(s)
- Marjolein E de Vugt
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Banningh LWAJW, Vernooij-Dassen MJFJ, Vullings M, Prins JB, Rikkert MGMO, Kessels RPC. Learning to live with a loved one with mild cognitive impairment: effectiveness of a waiting list controlled trial of a group intervention on significant others' sense of competence and well-being. Am J Alzheimers Dis Other Demen 2013; 28:228-38. [PMID: 23528880 PMCID: PMC10852931 DOI: 10.1177/1533317513481093] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This controlled study examines the efficacy of a comprehensive group program aimed at care partners of patients with mild cognitive impairment (MCI), which comprises elements of psychoeducation, cognitive rehabilitation, and cognitive behavioral therapy. Pre- and posttreatment quantitative and qualitative data were collected in the significant others of 84 patients with MCI, 27 of whom had first been assigned to a waiting list, thus serving as their own control group. Also, the significant others rated their sense of competence, well-being, distress, acceptance, helplessness, and awareness. Quantitative data analysis did not reveal statistically significant differences between the control and the intervention condition, but qualitative results suggest that at program completion the significant others reported gains in knowledge, insight, acceptance, and coping skills. In the present sample of significant others, the group intervention was not proven effective. Suggestions for program adjustments and alternative outcome measures are discussed.
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Affiliation(s)
- Liesbeth W. A. Joosten-Weyn Banningh
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Myrra J. F. J. Vernooij-Dassen
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen, Nijmegen, the Netherlands
- Kalorama Foundation, Beek-Ubbergen, the Netherlands
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Marjon Vullings
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Medical Psychology, VieCurie Hospital, Venlo, the Netherlands
| | - Judith B. Prins
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Roy P. C. Kessels
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands
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Abstract
SummaryHuman sexuality is a complex interaction of biological, social and emotional factors. When any or all of these factors are disrupted by a progressive dementia it is unsurprising that sexual ‘problems’ are identified. Most sexual behaviour ‘problems’ relate to expressions of normal sexuality complicated by changes in relationships, care needs and cognitive function, and complex ethical and legal considerations emerge. Rarely, new and severe hypersexual or paraphilic behaviours arise de novo, usually due to damage to certain brain areas, and sometimes due to medication side-effects, psychiatric disorder or delirium. Evidence and approaches to assess and to manage sexual behaviour problems in dementia are discussed.
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Mild Cognitive Impairment and Caregiver Burden: A Critical Review and Research Agenda. Public Health Rev 2012. [DOI: 10.1007/bf03391684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Davies HD, Sridhar SB, Newkirk LA, Beaudreau SA, O'Hara R. Gender differences in sexual behaviors of AD patients and their relationship to spousal caregiver well-being. Aging Ment Health 2011; 16:89-101. [PMID: 21999712 PMCID: PMC3358115 DOI: 10.1080/13607863.2011.609532] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Little is known about gender differences in sexuality among community-dwelling heterosexual couples in which one partner has Alzheimer's disease (AD). Few studies have examined gender differences in specific sexual behaviors or their associations with caregiver well-being. This study evaluated the impact of gender differences on intimacy and sexual satisfaction in marital relationships in which one partner has AD. METHOD Baseline measures were collected from 162 AD patients and their partners enrolled in a multi-site study between 2001 and 2009 to evaluate gender differences in measures of intimacy, caregiver well-being, and patient sexual behaviors. RESULTS While over 70% of all patients initiated physically intimate activities (i.e., kissing, hugging, and intercourse), most did not initiate intercourse specifically. Female caregivers reported higher levels of stress and depressive symptoms than male caregivers (p < 0.01). Satisfaction with intimacy was significantly associated with fewer stress and depressive symptoms in female caregivers (r = -0.29, p < 0.01). Caregiver gender, satisfaction with intimacy, and caring for a patient with mild AD were significant predictors of caregiver depressive symptoms (p's < 0.05). CONCLUSION The majority of couples dealing with AD reported engaging in intimacy, suggesting its importance in the relationship. Female caregivers who reported less sexual satisfaction reported more frequent stress and depressive symptoms. Caregiver gender, satisfaction with intimacy, and the AD patient's level of cognitive functioning significantly contributed to caregiver well-being. Gender-specific therapies to address patient sexual difficulties and caregiver well-being could potentially maintain or improve the marital relationship.
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Affiliation(s)
- Helen D Davies
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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