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Serbser-Koal J, Rommerskirch-Manietta M, Purwins D, Roes M. Person-centredness in dementia care: an integrative review of theoretical approaches. BMJ Open 2024; 14:e085051. [PMID: 38951009 PMCID: PMC11218012 DOI: 10.1136/bmjopen-2024-085051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/04/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVES This review identifies and examines theoretical approaches (components and objectives) to person-centred dementia care in order to obtain a better understanding of what is meant by the concept of person-centred dementia care. DESIGN Following the approach of Whittemore and Knafl, an integrative literature review was conducted to answer the following questions: (1) Which theoretical approaches to person-centred dementia care have been published? (2) What are the components of the theoretical approaches to person-centred dementia care thus identified, and which objectives can be identified? DATA SOURCES MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycINFO (via EBSCO) were searched through to 26 April 2021. ELIGIBILITY CRITERIA We included any kind of published literature that describes theoretical approaches to person-centred dementia care and that was written in German or English. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data. Data were pooled using a data extraction form developed by the Joanna Briggs Institute. A qualitative content analysis was conducted. RESULTS The analysis revealed heterogeneous perspectives within the identified approaches to person-centred dementia care. Statements pertaining to the components and objectives could be assigned to three different subcategories (microlevel, macrolevel and application level). This analysis enabled an enhanced understanding of how person-centred dementia care is currently described and whether and how the theoretical approaches differ in terms of their orientations and their focus on the individual and/or on sociality, which allows conclusions regarding the underlying conceptual idea of personhood. CONCLUSIONS There is a clear challenge for future research to overcome the dominance of the focus on the individual and to consider aspects of sociality to be at least equally important. This is needed in order to understand dementia as a multifaceted phenomenon that demands a differentiated consideration of theoretical notions of how to understand personhood in this context.
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Affiliation(s)
- Jonathan Serbser-Koal
- Deutsches Zentrum für Neurodegenerative Erkrankungen Standort Witten, Witten, Germany
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen Standort Witten, Witten, Germany
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Daniel Purwins
- Deutsches Zentrum für Neurodegenerative Erkrankungen Standort Witten, Witten, Germany
- Diakonie Osnabrück Stadt und Land, Osnabrück, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen Standort Witten, Witten, Germany
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
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Serbser-Koal J, Dreyer J, Roes M. Autonomy and its relevance for the construction of personhood in dementia- a thematic synthesis. BMC Geriatr 2024; 24:255. [PMID: 38486169 PMCID: PMC10941450 DOI: 10.1186/s12877-024-04808-6] [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: 01/30/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND This article examines the concept of autonomy in the context of person-centred dementia research and care, which is frequently being used but not clearly defined. Also, there is no clear conceptual relation between autonomy and personhood in this context. METHODS Therefore, literature on person-centred dementia research and care was examined to answer the following question: How is the concept of autonomy discussed in person-centred dementia research and care literature? RESULTS This analysis revealed heterogeneous perspectives on autonomy within the context of dementia. These were assigned to two different perspectives on personhood: one that links personhood to the existing cognitive abilities and the other one, that understands personhood relationally as the result of a socially constructed process. These results are discussed with regard to a nursing and care practice that could be considered as being deficit-oriented, but also with regard to the concept of social health in dementia. CONCLUSIONS Derived from this analysis, there is a clear need for general conceptual sensitivity in this field. Also, an in-depth examination of the social constructionist approach to personhood in the context of dementia is warranted.
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Affiliation(s)
- Jonathan Serbser-Koal
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer Str. 12, 58453, Witten, Germany.
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany.
| | - Jan Dreyer
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer Str. 12, 58453, Witten, Germany
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer Str. 12, 58453, Witten, Germany
- Department für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
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Paul J, Merz S, Bergholz A, König F, Weigt J, Eich-Krohm A, Apfelbacher C, Holmberg C. Social health: rethinking the concept through social practice theory and feminist care ethics. MEDICAL HUMANITIES 2023; 49:752-759. [PMID: 37657910 DOI: 10.1136/medhum-2022-012535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 09/03/2023]
Abstract
The social sciences have long shown that health is not born of pure biology, empirically (re)centred the social and material causes of disease, and affirmed the subjective experiences of disease. Disputed both in popular and academic discourses, social health has variously attempted to stress the social aspects of health. Existing conceptions remain analytically limited as they are predominantly used as descriptors for populational health. This article theorises social health as an analytical lens for making sense of the relations, affects and events where health unfolds and comes into expression. Drawing on social practice theory, feminist care ethics and posthumanism this conceptual paper re-imagines how social health might be conceived as lived social practices anchored in care. Care within our framework acknowledges the unavoidable interdependency foundational to the existence of beings and stresses the 'know how' and embodied practices of care in the mundane in order to emphasise that care itself is absolutely integral to the maintenance of social health. The article argues that health needs to be understood as a verb intrinsically (re)made in and through social contexts and structures and comprised of meaningful, human-human and human-non-human interactions. Ultimately, in theorising social health through mundane care practices, we hope to open up research to making sense of how the doing of health unfolds inside often banal, patterned forms of social activity. Such taken-for-granted social practices exemplify the often overlooked lived realities that comprise our health. To understand health in its own right, we argue, these everyday practices need to be interrogated.
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Affiliation(s)
- Joshua Paul
- Institute for Social Medicine and Epidemiology, Medizinische Hochschule Brandenburg CAMPUS GmbH, Neuruppin, Germany
| | - Sibille Merz
- Institute for Social Medicine and Epidemiology, Medizinische Hochschule Brandenburg CAMPUS GmbH, Neuruppin, Germany
| | - Andreas Bergholz
- Institute for Social Medicine and Epidemiology, Medizinische Hochschule Brandenburg CAMPUS GmbH, Neuruppin, Germany
| | - Franziska König
- Institute for Social Medicine and Epidemiology, Medizinische Hochschule Brandenburg CAMPUS GmbH, Neuruppin, Germany
| | - Julia Weigt
- Faculty of Medicine, Otto-von-Guericke-University Magdeburg Institute of Social Medicine and Health Economics, Magdeburg, Germany
| | - Astrid Eich-Krohm
- Faculty of Medicine, Otto-von-Guericke-University Magdeburg Institute of Social Medicine and Health Economics, Magdeburg, Germany
| | - Christian Apfelbacher
- Faculty of Medicine, Otto-von-Guericke-University Magdeburg Institute of Social Medicine and Health Economics, Magdeburg, Germany
| | - Christine Holmberg
- Institute for Social Medicine and Epidemiology, Medizinische Hochschule Brandenburg CAMPUS GmbH, Neuruppin, Germany
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Jeon YH, Krein L, O’Connor CMC, Mowszowski L, Duffy S, Seeher K, Rauch A. A Systematic Review of Quality Dementia Clinical Guidelines for the Development of WHO's Package of Interventions for Rehabilitation. THE GERONTOLOGIST 2023; 63:1536-1555. [PMID: 36043424 PMCID: PMC10581378 DOI: 10.1093/geront/gnac105] [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: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES As part of the WHO Rehabilitation 2030 call for action, the WHO Rehabilitation Programme is developing its Package of Interventions for Rehabilitation (PIR) to support ministries of health around the globe in integrating rehabilitation services into health systems. As a vital step for this PIR development, we conducted a systematic review of clinical practice guidelines (CPGs) for dementia to identify interventions for rehabilitation and related evidence. RESEARCH DESIGN AND METHODS Following WHO Rehabilitation Programme and Cochrane Rehabilitation's methodology, quality CPGs published in English between January 2010 and March 2020 were identified using PubMed, Embase, CINAHL, PEDro, Google Scholar, guideline databases, and professional society websites. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation (II). RESULTS Of the 22 CPGs that met the selection criteria, 6 satisfied the quality evaluation. Three hundred and thirty rehabilitation-related recommendations were identified, mostly concentrated in the areas of cognition, emotion, and carer support. There were many strong interventions, with moderate- to high-quality evidence that could be easily introduced in routine practice. However, major limitations were found both in the quality of evidence and scope, especially in areas such as education and vocation, community and social life, and lifestyle modifications. DISCUSSION AND IMPLICATIONS Further rigorous research is needed to build quality evidence in dementia rehabilitation in general, and especially in neglected areas for rehabilitation. Future work should also focus on the development of CPGs for dementia rehabilitation. A multipronged approach is needed to achieve Universal Health Coverage for dementia rehabilitation.
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Affiliation(s)
- Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Luisa Krein
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Claire M C O’Connor
- Centre for Positive Ageing, HammondCare, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Loren Mowszowski
- Brain and Mind Centre & School of Psychology, The University of Sydney, Sydney, Australia
| | - Shantel Duffy
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katrin Seeher
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alexandra Rauch
- Rehabilitation Programme, World Health Organization, Geneva, Switzerland
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Vernooij-Dassen M, Verspoor E, Samtani S, Sachdev PS, Ikram MA, Vernooij MW, Hubers C, Chattat R, Lenart-Bugla M, Rymaszewska J, Szczesniak D, Brodaty H, Welmer AK, Maddock J, van der Velpen IF, Wiegelmann H, Marseglia A, Richards M, Melis R, de Vugt M, Moniz-Cook E, Jeon YH, Perry M, Wolf-Ostermann K. Recognition of social health: A conceptual framework in the context of dementia research. Front Psychiatry 2022; 13:1052009. [PMID: 36590639 PMCID: PMC9798783 DOI: 10.3389/fpsyt.2022.1052009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The recognition of dementia as a multifactorial disorder encourages the exploration of new pathways to understand its origins. Social health might play a role in cognitive decline and dementia, but conceptual clarity is lacking and this hinders investigation of associations and mechanisms. The objective is to develop a conceptual framework for social health to advance conceptual clarity in future studies. Process We use the following steps: underpinning for concept advancement, concept advancement by the development of a conceptual model, and exploration of its potential feasibility. An iterative consensus-based process was used within the international multidisciplinary SHARED project. Conceptual framework Underpinning of the concept drew from a synthesis of theoretical, conceptual and epidemiological work, and resulted in a definition of social health as wellbeing that relies on capacities both of the individual and the social environment. Consequently, domains in the conceptual framework are on both the individual (e.g., social participation) and the social environmental levels (e.g., social network). We hypothesize that social health acts as a driver for use of cognitive reserve which can then slow cognitive impairment or maintain cognitive functioning. The feasibility of the conceptual framework is demonstrated in its practical use in identifying and structuring of social health markers within the SHARED project. Discussion The conceptual framework provides guidance for future research and facilitates identification of modifiable risk and protective factors, which may in turn shape new avenues for preventive interventions. We highlight the paradigm of social health in dementia as a priority for dementia research.
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Affiliation(s)
- Myrra Vernooij-Dassen
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eline Verspoor
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Suraj Samtani
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
| | - Perminder S. Sachdev
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Claudia Hubers
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | | | - Dorota Szczesniak
- Department of Psychiatry, Wrocław Medical University, Wrocław, Poland
| | - Henry Brodaty
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
- Dementia Centre for Research Collaboration, Sydney, NSW, Australia
| | - Anna-Karin Welmer
- Department of Neurobiology Care Sciences and Society, Aging Research Center & Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Jane Maddock
- MRC Unit for Lifelong Health and Ageing at UCL, Faculty of Population Health, University College London, London, United Kingdom
| | - Isabelle F. van der Velpen
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Henrik Wiegelmann
- Department of Nursing Science Research, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Anna Marseglia
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, Faculty of Population Health, University College London, London, United Kingdom
| | - Rene Melis
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neurosciences, Faculty of Health, Medicine and Life Sciences, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherland
| | - Esme Moniz-Cook
- Department of Clinical Psychology, University of Hull, Hull, United Kingdom
| | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Marieke Perry
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Karin Wolf-Ostermann
- Department of Nursing Science Research, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
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Innes A, Chesterton L, Morris L, Smith SK, Bushell S. Perspectives of people living with dementia and their care partners about the impact on social health when participating in a co-designed Dementia café. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1375-e1383. [PMID: 34407284 DOI: 10.1111/hsc.13545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/29/2021] [Accepted: 07/11/2021] [Indexed: 06/13/2023]
Abstract
Those diagnosed with dementia and those who provide care and support often feel socially isolated with limited opportunities for social engagement, increasing the potential for loneliness and further isolation that is detrimental to social health. This study examined how a co-designed dementia café impacted on the self-reported social health of community dwelling people with dementia and their care partners in the North-West of England. Semi-structured interviews were conducted at two time periods (summer of 2019 and spring of 2020), with five people living with dementia and eight care partners. The key finding was that participating in the cafés led to a sense of belonging and purpose that was beneficial to well-being and social health for all participants. Community-based initiatives that provide opportunities for peer support for the person with the diagnosis and the care partner are essential so that people living with dementia may rebuild their confidence as well as retaining opportunities to socialise.
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Affiliation(s)
- Anthea Innes
- Salford Institute for Dementia and Ageing, University of Salford, Salford, UK
| | - Lorna Chesterton
- Salford Institute for Dementia and Ageing, University of Salford, Salford, UK
- Social Ageing Cluster, Manchester Metropolitan University, Manchester, UK
| | - Lydia Morris
- Salford Institute for Dementia and Ageing, University of Salford, Salford, UK
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Sarah K Smith
- Enterprise and Education Specialist in Ageing and Dementia, Salford Institute for Dementia & Ageing, University of Salford, Manchester, UK
| | - Sophie Bushell
- Salford Institute for Dementia & Ageing, University of Salford, Manchester, UK
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Seifert I, Wiegelmann H, Lenart-Bugla M, Łuc M, Pawłowski M, Rouwette E, Rymaszewska J, Szcześniak D, Vernooij-Dassen M, Perry M, Melis R, Wolf-Ostermann K, Gerhardus A. Mapping the complexity of dementia: factors influencing cognitive function at the onset of dementia. BMC Geriatr 2022; 22:507. [PMID: 35725402 PMCID: PMC9208220 DOI: 10.1186/s12877-022-02955-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background Dementia is a multi-factorial condition rather than a natural and inevitable consequence of ageing. Some factors related to dementia have been studied much more extensively than others. To gain an overview of known or suspected influential factors is a prerequisite to design studies that aim to identify causal relationships and interactions between factors. This article aims to develop a visual model that a) identifies factors related to cognitive decline that signal the onset of dementia, b) structures them by different domains and c) reflects on and visualizes the possible causal links and interactions between these factors based on expert input using a causal loop diagram. Method We used a mixed-method, step-wise approach: 1. A systematic literature review on factors related to cognitive decline; 2. A group model building (GMB) workshop with experts from different disciplines; 3. Structured discussions within the group of researchers. The results were continuously synthesized and graphically transformed into a causal loop diagram. Results The causal loop diagram comprises 73 factors that were structured into six domains: physical (medical) factors (23), social health factors (21), psychological factors (14), environmental factors (5), demographic factors (5) and lifestyle factors (3). 57 factors were identified in the systematic literature review, additionally 16 factors, mostly of the social health cluster, were identified during the GMB session and the feedback rounds. Conclusion The causal loop diagram offers a comprehensive visualisation of factors related to cognitive decline and their interactions. It supports the generation of hypotheses on causal relationships and interactions of factors within and between domains. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02955-2.
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Affiliation(s)
- Imke Seifert
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), Health Sciences Bremen, University of Bremen, Grazer Straße 4 , 28359, Bremen, Germany.
| | - Henrik Wiegelmann
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), Health Sciences Bremen, University of Bremen, Bremen, Germany
| | | | - Mateusz Łuc
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Pawłowski
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Etienne Rouwette
- Methodology Department, University of Nijmegen, Nijmegen, The Netherlands
| | | | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Myrra Vernooij-Dassen
- Faculty of Medical Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - René Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karin Wolf-Ostermann
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Ansgar Gerhardus
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), Health Sciences Bremen, University of Bremen, Grazer Straße 4 , 28359, Bremen, Germany
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The Experiences of People with Dementia and Informal Carers Related to the Closure of Social and Medical Services in Poland during the COVID-19 Pandemic-A Qualitative Study. Healthcare (Basel) 2021; 9:healthcare9121677. [PMID: 34946403 PMCID: PMC8702134 DOI: 10.3390/healthcare9121677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023] Open
Abstract
Older people with dementia are particularly at risk of COVID-19; however, relatively little is known about the indirect impact of the pandemic on the lives of those living with, and/or caring for someone with, dementia. The aim of this study was to investigate the experiences of people with dementia and informal carers during the closure of available social and medical services in Poland during the COVID-19 pandemic. A qualitative thematic analysis of semi-structured interviews with people with dementia (n = 5) and informal carers (n = 21) was performed between June and August 2020 after the first wave of COVID-19 in Poland. Three overarching themes were identified: (1) care re-organization; (2) psychological responses; (3) emerging needs. The factor underlying all these elements was reliance on other people. Social support and engagement are vital to the ongoing health and well-being of people living with dementia and their informal carers. Services need to be strengthened to provide ongoing provision to those living with dementia to reach pre-pandemic levels, if not better. Within the post-pandemic environment, people with dementia and their informal carers need reassurance that they can rely on external institutional and social support able to meet their needs.
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Feasibility and acceptability evaluation of the Promoting Independence in Dementia (PRIDE) intervention for living well with dementia. Int Psychogeriatr 2021; 33:601-614. [PMID: 32847643 DOI: 10.1017/s1041610220001386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Post-diagnostic psychosocial interventions could play an important role in supporting people with mild dementia remain independent. The Promoting Independence in Dementia (PRIDE) intervention was developed to address this. METHOD The mixed methods non-randomized, pre-post feasibility study occurred across England. Facilitators were recruited from the voluntary sector and memory services. Participants and their supporters took part in the three-session intervention. Outcome measures were collected at baseline and follow-up. To evaluate acceptability, focus groups and interviews were conducted with a subsample of participants and facilitators. RESULTS Contextual challenges to delivery including national research governance changes, affected recruitment of study sites. Thirty-four dyads consented, with 14 facilitators providing the intervention. Dyads took part in at least two sessions (79%), and 73% in all three. Outcome measures were completed by 79% without difficulty, with minimal missing data. No significant changes were found on pre and post assessments. Post hoc analysis found moderate effect size improvements for self-management (SMAS instrument) in people with dementia (d = 0.41) and quality of life (EQ5D measure) in carers (d = 0.40). Qualitative data indicated that dyads found PRIDE acceptable, as did intervention facilitators. CONCLUSIONS The three-session intervention was well accepted by participant-dyads and intervention facilitators. A randomized controlled trial of PRIDE would need to carefully consider recruitment potential across geographically varied settings and site stratification according to knowledge of contextual factors, such as the diversity of post-diagnostic services across the country. Letting sites themselves be responsible for identifying suitable intervention facilitators was successful. The self-report measures showed potential to be included in the main trial.
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Stasiulis E, Rapoport MJ, Sivajohan B, Naglie G. The Paradox of Dementia and Driving Cessation: "It's a Hot Topic," "Always on the Back Burner". THE GERONTOLOGIST 2021; 60:1261-1272. [PMID: 32301497 DOI: 10.1093/geront/gnaa034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the well-recognized difficulty that persons with dementia and family carers experience in the decision making and transition to nondriving, there are few interventions and resources to support them. As part of our ongoing research to develop a driving cessation toolkit that addresses this gap, we sought to examine the context-specific factors relevant to its effective implementation in settings that support older adults with dementia. RESEARCH DESIGN AND METHODS A qualitative descriptive approach was used to explore the perspectives of Alzheimer Society (AS) staff in their work of supporting people with dementia and family carers within the context of driving cessation. Individual in-depth interviews were conducted with 15 AS staff members in 4 Canadian provinces. Data were examined using interpretative thematic analysis. RESULTS The study results revealed an overarching paradox that despite the importance of driving cessation in people with dementia, it continues to be largely avoided at the individual and system levels. This is explored via the themes of (a) paradox of importance and avoidance identified in AS settings; (b) lack of awareness and understanding about dementia and driving among people with dementia and family carers; (c) distress and avoidance rooted in ongoing system issues; and (d) moving driving cessation to the "front burner." DISCUSSION AND IMPLICATIONS Viewed through the emerging social health paradigm, which focuses on the social and emotional consequences of dementia, our results highlight the urgent need to mobilize our communities, medical education systems, and transportation authorities to finally resolve the dementia and driving cessation paradox.
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Affiliation(s)
- Elaine Stasiulis
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Brintha Sivajohan
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Gary Naglie
- Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Departments of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
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Abstract
Abstract
‘Dementia-friendly communities’ herald a shift toward the neighbourhood as a locus for the care and support of people with dementia, sparking growing interest in the geographies of dementia care and raising questions over the shifting spatial and social experience of the condition. Existing research claims that many people with dementia experience a ‘shrinking world’ whereby the boundaries to their social and physical worlds gradually constrict over time, leading to a loss of control and independence. This paper reports a five-year, international study that investigated the neighbourhood experience of people with dementia and those who care for and support them. We interrogate the notion of a shrinking world and in so doing highlight an absence of attention paid to the agency and actions of people with dementia themselves. The paper draws together a socio-relational and embodied-material approach to question the adequacy of the shrinking world concept as an explanatory framework and to challenge reliance within policy and practice upon notions of place as fixed or stable. We argue instead for the importance of foregrounding ‘lived place’ and attending to social practices and the networks in which such practices evolve. Our findings have implications for policy and practice, emphasising the need to bolster the agency of people living with dementia as a route to fostering accessible and inclusive neighbourhoods.
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Vernooij-Dassen M, Moniz-Cook E, Verhey F, Chattat R, Woods B, Meiland F, Franco M, Holmerova I, Orrell M, de Vugt M. Bridging the divide between biomedical and psychosocial approaches in dementia research: the 2019 INTERDEM manifesto. Aging Ment Health 2021; 25:206-212. [PMID: 31771338 DOI: 10.1080/13607863.2019.1693968] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To provide a new perspective on integrated biomedical and psychosocial dementia research. BACKGROUND Dementia is being recognized as a multifactorial syndrome, but there is little interaction between biomedical and psychosocial approaches. A way to improve scientific knowledge is to seek better understanding of the mechanisms underlying the interaction between biomedical and psychosocial paradigms. One rationale for integrating biomedical and psychosocial research is the discordance between neuropathology and cognitive functioning. The concept of social health might bridge the two paradigms. It relates to how social resources influence the dynamic balance between capacities and limitations. HYPOTHESES Social health can act as the driver for accessing cognitive reserve, in people with dementia through active facilitation and utilization of social and environmental resources. Thereby we link lifestyle social and opportunities to the brain reserve hypothesis. MANIFESTO We provide a Manifesto on how to significantly move forward the dementia research agenda.
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Affiliation(s)
- Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esme Moniz-Cook
- Faculty of Health Sciences, School of Health & Social Work, University of Hull, Hull, UK
| | - Frans Verhey
- Alzheimer Centrum Limburg, School of Mental Health & Neurosciences/Psychiatry and Psychology/MUMC, Maastricht, The Netherlands
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Bob Woods
- Dementia Services Development Centre, DSDC Wales, Bangor University, Ardudwy, Bangor, UK
| | - Franka Meiland
- Department of Psychiatry, Amsterdam University Medical Centers, Location VUmc, APH Research Institute, Amsterdam, the Netherlands
| | - Manuel Franco
- Department Psychiatry, University Rio Hortega Hospital (Valladolid) and Zamora Hospital (Zamora), Spain.,Psychiatric and Mental Health Department, University Rio Hortega Hospital and Zamora Hospital, Zamora, Spain
| | - Iva Holmerova
- Charles University FHS CELLO and Gerontologicke Centrum, Kobylisy, Czechia
| | - Martin Orrell
- The Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - Marjolein de Vugt
- Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, the Netherlands
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Appel L, Ali S, Narag T, Mozeson K, Pasat Z, Orchanian-Cheff A, Campos JL. Virtual reality to promote wellbeing in persons with dementia: A scoping review. J Rehabil Assist Technol Eng 2021; 8:20556683211053952. [PMID: 35024166 PMCID: PMC8743938 DOI: 10.1177/20556683211053952] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/12/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
Virtual Reality (VR) technologies have increasingly been considered potentially valuable tools in dementia-related research and could serve as non-pharmacological therapy to improve quality of life (QoL) and wellbeing for persons with dementia (PwD). In this scoping review, we summarize peer-reviewed articles published up to Jan-21, 2021, on the use of VR to promote wellbeing in PwD. Eighteen manuscripts (reporting on 19 studies) met the inclusion criteria, with a majority published in the past 2 years. Two reviewers independently coded the articles regarding A) intended clinical outcomes and effectiveness of the interventions, B) study sample (characteristics of the participants), C) intervention administration (by whom, what setting), D) experimental methods (design/instruments), and E) technical properties of the VR-systems (hardware/devices and software/content). Emotional outcomes were by far the most common objectives of the interventions, reported in seventeen (89.5%) of the included articles. Outcomes addressing social engagement and personhood in PwD have not been thoroughly explored using VR. Based on the positive impact of VR, future opportunities lie in identifying special features and customization of the hardware/software to afford the most benefit to different sub-groups of the target population. Overall, this review found that VR represents a promising tool for promoting wellbeing in PwD, with positive or neutral impact reported on emotional, social, and functional aspects of wellbeing.
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Affiliation(s)
- Lora Appel
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Suad Ali
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Tanya Narag
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Krystyna Mozeson
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Zain Pasat
- McMaster University, Hamilton, ON, Canada
| | | | - Jennifer L Campos
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
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Doherty KV, Nguyen H, Eccleston CEA, Tierney L, Mason RL, Bindoff A, Robinson A, Vickers J, McInerney F. Measuring consumer access, appraisal and application of services and information for dementia (CAAASI-Dem): a key component of dementia literacy. BMC Geriatr 2020; 20:484. [PMID: 33213386 PMCID: PMC7678312 DOI: 10.1186/s12877-020-01891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ability to locate, navigate and use dementia services and information, either for oneself or in providing care for others, is an essential component of dementia literacy. Despite dementia literacy being understood to be inadequate in many settings, no validated instrument exists to measure these elements. Here we describe the development and preliminary validation of the Consumer Access, Appraisal and Application of Services and Information for Dementia (CAAASI-Dem) tool. METHODS Items were adapted from existing health literacy tools and guided by discussion posts in the Understanding Dementia Massive Open Online Course (UDMOOC). Following expert review and respondent debriefing, a modified CAAASI-Dem was administered to UDMOOC participants online. On the basis of descriptive statistics, inter-item and item total correlations and qualitative feedback, this was further refined and administered online to a second cohort of UDMOOC participants. Exploratory factor analysis identified underlying factor structure. Items were retained if they had significant factor loadings on one factor only. Each factor required at least three items with significant factor loadings. Internal consistency of factors in the final model was evaluated using Cronbach's alpha coefficients. RESULTS From a pool of 70 initial items with either a 5-point Likert scale (Not at all confident - Extremely confident; or Strongly agree - Strongly disagree) or a binary scale (Yes - No), 65 items were retained in CAAASI-Dem-V1. Statistical and qualitative analysis of 1412 responses led to a further 34 items being removed and 11 revised to improve clarity. The 31 item CAAASI-Dem-V2 tool was subsequently administered to 3146 participants, one item was removed due to redundancy and EFA resulted in the removal of an additional 4 items and determination of a five factor structure: Evaluation and engagement; Readiness; Social supports; Specific dementia services; and Practical aspects. CONCLUSIONS The five factors and 26 constituent items in CAAASI-Dem align with functional, critical, and communicative aspects of dementia health literacy from the perspective of the carer. As a screening tool for people living with dementia and their carers, CAAASI-Dem potentially provides a means to determine support needs and may be a key component of the dementia literacy assessment toolbox.
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Affiliation(s)
- Kathleen Veronica Doherty
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, 7001, Australia.
| | - Hoang Nguyen
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, 7001, Australia
| | - Claire E A Eccleston
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, 7001, Australia
| | - Laura Tierney
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, 7001, Australia
| | - Ron L Mason
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, 7001, Australia
| | - Aidan Bindoff
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, 7001, Australia
| | - Andrew Robinson
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, 7001, Australia
| | - James Vickers
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, 7001, Australia
| | - Fran McInerney
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, 7001, Australia
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Clarke C, Woods B, Moniz-Cook E, Mountain G, Øksnebjerg L, Chattat R, Diaz A, Gove D, Vernooij-Dassen M, Wolverson E. Measuring the well-being of people with dementia: a conceptual scoping review. Health Qual Life Outcomes 2020; 18:249. [PMID: 32709238 PMCID: PMC7382062 DOI: 10.1186/s12955-020-01440-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/05/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Enabling people with dementia to 'live well' is a policy and research priority in many countries. However, instruments for measuring outcomes of psychosocial interventions designed to promote well-being in dementia are often derived from a symptom-focused, loss/deficit approach, or from broad quality of life concepts. A pan-European dementia working group called for research on the development of an alternative asset/strengths-based conceptual framework of well-being in dementia. This paper takes forward this recommendation by developing such a framework and using this to map relevant self-report outcome measures. METHODS Three scoping reviews of published studies were conducted iteratively. First, we examined the literature on lived experiences of well-being and quality of life in people with dementia and then the wider dementia literature for application of well-being constructs. The synthesised findings generated conceptual domains of well-being in people with dementia. Corresponding self-report instruments used in dementia research were scoped, categorised within the conceptual framework and their potential value in measuring outcomes for people with dementia was examined. FINDINGS Six conceptual domains for the measurement of well-being and 35 self-report instruments that have been used with people with dementia were identified. Six instruments were developed specifically for people with dementia, five were derived from the gerontological literature and 24 from the well-being literature. Fifteen instruments and one sub-scale have been examined for psychometric properties amongst people with dementia. To date, 20 have been used as outcome measures, with seven measuring change over time. A number of identified instruments utilise traditional retrospective Likert-scaling response formats, limiting their potential for use with some groups of people with dementia. CONCLUSION An assets/strengths-based framework is presented, outlining structural domains for selecting self-report measures of well-being in people with dementia. It provides a foundation for enhancing research into processes and outcomes of psychosocial interventions, including instrument development, more precise matching of intervention aims with outcome measurement, and newer technology-based 'in-the-moment' measurement.
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Affiliation(s)
- Chris Clarke
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
| | - Bob Woods
- DSDC Wales, Bangor University, Ardudwy, Holyhead Road, Bangor, Gwynedd LL57 2PZ UK
| | - Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
| | - Gail Mountain
- School of Dementia Studies, University of Bradford, Richmond Rd, Bradford, BD7 1DP UK
| | - Laila Øksnebjerg
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Section 6922, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Rabih Chattat
- Department of Psychology Università di Bologna - Via Zamboni, 33 - 40126 Bologna, Italy
| | - Ana Diaz
- Alzheimer Europe, L-1417 14, rue Dicks, Luxembourg
| | - Dianne Gove
- Alzheimer Europe, L-1417 14, rue Dicks, Luxembourg
| | - Myrra Vernooij-Dassen
- Radboud University Medical Centre, Scientific Center for Quality of Healthcare, IQ Healthcare 114, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - Emma Wolverson
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
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Clark A, Campbell S, Keady J, Kullberg A, Manji K, Rummery K, Ward R. Neighbourhoods as relational places for people living with dementia. Soc Sci Med 2020; 252:112927. [DOI: 10.1016/j.socscimed.2020.112927] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
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Self-management and social participation in community-dwelling people with mild dementia: a review of measuring instruments. Int Psychogeriatr 2019; 31:1267-1285. [PMID: 30724149 DOI: 10.1017/s1041610218001709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In order to evaluate interventions promoting social health in people with dementia it is essential to have reliable and valid measures. The present review aims to provide an overview of available instruments for the assessment of two domains of social health in community-dwelling people with mild dementia, i.e., the ability to manage life with some degree of independence (self-management) and participation in social activities. METHODS An electronic search was conducted in the following databases: PubMed, CINAHL, and PsycINFO. Characteristics of the instruments, feasibility and psychometric properties of the instruments included are reported on. RESULTS We identified eight instruments measuring aspects of self-management and three instruments measuring social participation. Validity and reliability of self-management instruments varied between moderate and good. Little information was found on the psychometric properties of the instruments for social participation. In general, feasibility and responsiveness data regarding application in community-dwelling people with dementia were scarce for both types of instruments. CONCLUSIONS Future research into assessment tools for social health should focus on the development of instruments for self-management that also cover the areas of coping with and adapting to the emotional consequences of the disease; instruments for social participation covering the involvement in social interactions that are experienced as meaningful by the person; and on the psychometric properties and responsiveness of instruments. More attention should also be given to the feasibility (ease of use) of these instruments for people with mild dementia, professionals, and researchers.
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Abstract
Social aspects of dementia are becoming increasingly important as part of a wider shift in emphasis from cure to care. This is partly because approaches based on finding a cure have proved far more difficult and complex than originally imagined (WHO, 2016). New evidence on the effectiveness of public health measures, that while incidence is growing as the proportion of older people in society increases its prevalence amongst older adults is actually falling, has also lead to increased interest in social dimensions of prevention, lifestyle change, and practical intervention in community settings (Prince et al., 2016; Kivipelto et al., 2017). This, in turn, has led to a rediscovery of the role of supports to people living with dementia in their daily lives, the needs of informal carers, and professional activities that can maintain the social engagement of each party (Winblad et al., 2016). The expansion of practice around person-centered care, beyond traditional institutional settings, has also contributed to a socialized view of how interactions in dementia care are thought about (Bartlett et al., 2017), as has an increased awareness of the effects of the social construction of dementia in the public mind (Biggs, 2018). Most recently, people living with dementia, and particularly with respect to younger onset dementia, have begun to find a voice and to make connections to the wider disability movement (Dementia Alliance International, 2017). Each of these developments, in their different ways, have led to a re-emphasis on psycho-social elements of dementia, its experience, and how that might translate into clinical practice and service delivery.
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