Enabling work for people with dementia - Recommendations for interventions: A mixed-methods review

Worldwide, 50 million people are living with dementia. As more individuals develop dementia while still working, dementia will increasingly become a workplace issue and a societal concern. Interventions targeted at work retainment, can reduce, and postpone the loss of cognitive functioning following dementia. However, there is a small body of research focused on recommendations for work interventions for people with dementia. The aim of this mixed-methods review was to investigate experiences of work following a dementia diagnosis from the perspective of people with dementia, their relatives, employers, co-workers and HR-professionals, with the objective of formulating recommendations for work interventions for people with dementia. A mixed-method approach guided the review. 16 original studies published between 1989 to 2023 were included, with a collective sample of 684 participants. The review shows that it is possible to live and work well with dementia, if collaborative solutions are continuously negotiated to meet the needs of the person with dementia and the workplace, and with attention to possible contextual enablers and barriers. The review highlights four key elements for successful work interventions for people with dementia: 1) Person-centered Approach, 2) Contextual Relevance, 3) Knowledge-based and 4) Dynamic Approach.

'Too young to sit at home': a qualitative study conducted among employees with young-onset dementia and their relatives

OBJECTIVES

Young-onset dementia (YOD) symptoms often first present in the workplace, resulting in work performance challenges and eventually loss of employment. This study aims to investigate the experiences, work values, and support needs of employees with YOD and their relatives.

METHOD

Semi-structured interviews were conducted to explore the experiences, work values, and support needs of (former) employees with YOD and their relatives. Subsequently, separate focus group discussions were conducted for employees and relatives to review and prioritize interview findings. Inductive thematic analysis was applied to both datasets.

RESULTS

A total of 15 interviews (six employees; nine relatives) and four focus group discussions (ten employees; six relatives) were conducted. Six themes emerged, with five revolving around the central theme: desire to work. The other themes represent essential contributing factors, including importance of receiving a YOD diagnosis; knowledge, awareness, and understanding regarding YOD; open communication, joint decision making, and collaboration; work adjustments, involvement, and support; phasing out work and future perspectives.

CONCLUSION

The findings highlight a strong desire to work post-YOD diagnosis, serving as a foundation for developing workplace support tools and guidance. This has the potential to help individuals with YOD preserve their self-confidence and identity while working within their capabilities.

What happens when people develop dementia whilst working? An exploratory multiple case study

PURPOSE

This study is an in-depth exploration of the unfolding experiences of five persons who developed dementia while still in paid work/employment, and of their significant others. Namely, we explore how they experienced the actions and decisions taken with respect to work, and what the consequences meant to them.

METHODS

A qualitative longitudinal case study design with multiple cases was used, including five participants with dementia and significant others of their choice. Interviews were undertaken longitudinally and analysed with the Formal Data-Structure Analysis approach.

RESULTS

The joint analysis resulted in two intertwined themes: 1) The significance and consequences of a dementia diagnosis: a double-edged trigger, and 2) Sensemaking and agency. The prevalent images of what dementia is, who can/cannot get it and what it will bring, were revealed as the critical aspects. Having the opportunity to make sense of what has happened and participate in decision-making, contributed decisively to the participants' experiences.

CONCLUSIONS

Findings illustrate how a dementia diagnosis is alien in work-life, but once diagnosed, it may trigger self-fulfiling expectations based upon stereotypical understanding of dementia. A shift is needed from a deficit-focused perspective, to viewing people with dementia as citizens capable of agency.

Dementia, Work and Employability: Using the Capability Approach to Understand the Employability Potential for People Living with Dementia

The importance of remaining in, or re-entering, the labour market is emphasised by governments internationally. While this may bring benefits, progressive disabilities such as dementia affect an individual's employability. Although employers have legal obligations to support employees with disabilities, research suggests that employers are not providing this support to employees living with dementia and are undermining their capabilities. Drawing on interview data from 38 key informants collected over two studies, we explore the potential for supporting and promoting the employability of people living with dementia. A model of sustainable employability based on the Capability Approach is used as a lens to explore this issue. The findings demonstrate the implications of progressive disabilities for employability when the worker and their family are faced with dealing with a disability in a period of uncertainty with a lack of public and workplace understanding.

Work-related experiences of people living with young-onset dementia in Japan

Dementia that occurs before age 65 years is defined as young-onset dementia (YOD). YOD develops during the prime of a person's working life and has a major impact on not only work but life in general. Therefore, Japan is promoting measures to support work and social participation, taking into account the characteristics of people living with YOD. Given the rarity of YOD, few studies have examined the difficulties faced by people living with YOD during this life stage or the kinds of support they require. We believe that studying these difficulties and support requirements will contribute to prolonging the careers of people living with YOD and to providing them support during social, emotional and economic crises. This qualitative study aims to clarify the experiences of working-age Japanese people living with YOD to examine, from their perspective, possibilities for employment support. For this study, people living with YOD who were currently working were recruited by snowball sampling. This study was conducted in Japan between September 2018 and February 2019. A semi-structured interview was conducted, and the contents were transcribed and analysed using Colaizzi's qualitative methodology. Four categories were derived: (a) crisis from continuing to work, (b) seeking support, (c) overcoming challenges to work and (d) reaffirming a sense of purpose by resuming work and social participation. Participants were able to continue working and socialising by letting others know about their illness and seeking support. In the process of reaffirming a sense of purpose by resuming work and social participation, participants continued working or transitioned to socially active lives after leaving their job thanks to the support of work colleagues and medical and healthcare/welfare professionals who understand YOD. The results indicate a need for awareness raising in the workplace to promote understanding of such professional support and its significance.

Working towards inclusion: Creating technology for and with people living with mild cognitive impairment or dementia who are employed

Earlier diagnosis and longer working careers is resulting in more individuals being identified as having Mild Cognitive Impairment or Early Onset Dementia (MCI/EOD) when they are still in the workforce. While there is growing interest in the dementia research community and beyond to develop technologies to support people with dementia, the use of technology for and by people with MCI/EOD in the workplace has had very little attention. This paper presents a two-part study involving interviews and participatory sessions to begin to understand the workplace experiences and the role of technology among people living with MCI/EOD. We present our findings from working with seven people with MCI/EOD and two care partners to explore technology design. Our results indicate several similarities as well as a few differences between MCI/EOD and later-onset dementia with respect to challenges using technology and design considerations for supporting engagement and use of technology. Lessons learned through the process of working with people with MCI/EOD through participatory methods is presented along with recommendations to foster an inclusive, respectful, and empowering experience for participants with MCI/EOD.

Alcohol Use, Mental Health, and Functional Capacity as Predictors of Workplace Disability in a Cohort With Manifest Huntington's Disease

OBJECTIVE

Huntington's disease (HD) is an inherited neurodegenerative disease involving motor, cognitive, psychiatric, and behavioral impairments that eventually affect work-role functioning. There is limited research regarding predictors of workplace disability in HD. The authors examined predictors of work impairment and disability in a cross-sectional cohort of employed persons with symptomatic HD participating in the worldwide Enroll-HD study.

METHODS

The study sample (N=316) comprised individuals with manifest HD and a CAG repeat length range between 39 and 60 and were currently engaged in paid full- or part-time employment. Univariate and multivariate logistic regression analyses identified predictors and the effect of all predictors in a fully adjusted model.

RESULTS

Of the sample, 20.3% reported missing work due to HD, 60.1% reported experiencing impairment while working due to HD, 79.1% reported having work-related activity impairment due to HD, and 60.8% reported impairment in overall work productivity due to HD. Individuals had 25% higher odds of missing work time if they had a higher level of functional impairment (odds ratio=0.76, 95% CI=0.64, 0.91) and had three times greater odds of missing work if they were current alcohol drinkers, compared with nondrinkers (odds ratio=2.86, 95% CI=1.62, 5.03). Individuals with lower self-perceived mental health were also 5% more likely to experience impairment at work due to HD. Motor impairment was not a strong predictor of workplace disability.

CONCLUSIONS

These findings provide important new knowledge that can inform the development of strategies or targeted intervention trials to support persons with symptomatic HD to maintain their work roles.

Needs-appropriate services for people with young onset dementia: The perspectives of healthcare professionals

Young onset dementia has become a growing challenge in national healthcare systems. Concerns about the situation have already been expressed; however, they mostly report the views of services end-users. Aimed at finding out useful further improvement, interviews documenting the working experiences of professionals addressing healthcare services to people with young onset dementia (YOD) were analysed qualitatively. The interviews resulted in four themes and twelve categories. The themes regarded services' complexity and responsiveness, the levels of education and knowledge on YOD, the impact that serving people with YOD reflects on staff working experience and quality of life, and a series of proposals aimed at improving services by giving people with YOD and families the provision of care they deserve. Although some of the themes recapped the ones reported in the previous literature, the mixture of internally and externally driven instances represented in the themes depict the complexity of care delivery in the services. Findings are discussed in the light of a pragmatical framework capable of suggesting what changes services should implement to be timely responsive.

Dementia in the workplace: are employers supporting employees living with dementia?

OBJECTIVES

As working lives extend and there is better recognition of early-onset dementias, employers need to consider dementia as a workplace concern. With suitable support, people living with dementia can continue employment - although, this is not appropriate for all. The requirement for employers to support employees living with dementia has human rights and legal foundations. This article considers whether employers consider dementia as a workplace concern; and the policies and/or practices available to support employees living with dementia. Thus, it develops understanding of whether employers are meeting their human rights/legislative obligations.

METHOD

A sequential mixed-methods approach was employed, with data collection undertaken in Scotland (United Kingdom). An online survey was sent to employers across Scotland, with 331 participating. Thirty employer interviews were conducted, with the survey results informing the interview approach.

RESULTS

The survey and interview data were analyzed separately and then combined and presented thematically. The themes identified were (1) Dementia as a workplace concern, (2) Support for employees living with dementia and (3) Employer policy development and awareness raising. The findings demonstrate dementia awareness, but this knowledge is not applied to employment situations. There was little evidence suggesting that the rights of employees living with dementia are consistently upheld.

CONCLUSION

This research sends out strong messages about the rights and legal position of person living with dementia which cannot be ignored. The continuing potential of employees living with dementia and their legal rights are not consistently recognized. This highlights the need for robust training interventions for employers.

Keeping People with Dementia or Mild Cognitive Impairment in Employment: A Literature Review on Its Determinants

Background: Approximately 10–20% of people with early onset dementias (EOD) or mild cognitive impairment (MCI) are aged under 65 and, due to extended working life and increasing prevalence of dementias, they more and more frequently will be present in the active workforce. This review aimed to synthesize the available information about the ability of people with EOD or MCI to retain their participation in the labor workforce. Methods: We searched SCOPUS and EMBASE for peer-reviewed papers that reported studies assessing work ability in employees with EOD or MCI that were published in the period of January 2010 to August 2019. Results: We selected four publications, in which 1012 participants with EOD or MCI were enrolled (41.2% males). Cognitive difficulties rather than motor dysfunction were found to reduce patients’ ability to work. Two main themes emerged: management of dementia in the workplace and the impact of symptoms on working status. Conclusions: EOD and MCI impact on workforce participation by determining problems in executive functions. Although this review was based on a small sample of studies, it can be shown that support in the workplace may act as a facilitator to enhance workforce participation, and occupational health professionals can help patients with EOD or MCI continue working as much as possible.

Managing employees with dementia: a systematic review

BACKGROUND

The experience of developing dementia while in employment has been explored from the point of view of the employee, but less is known about the perspectives, experiences and needs of employers.

AIMS

To review systematically literature about the management of employees who develop dementia whilst in employment.

METHODS

Databases searched included MEDLINE, EMBASE, PsycINFO, CINAHL, BNI, ABI Inform, ISI Web of Science, Open Grey and dementia journals database; 44 documents were identified for inclusion in the review: 22 journal papers, one PhD thesis and 21 articles, reports and webpages from the grey literature. As all documents were qualitative in nature a thematic synthesis of their content was undertaken.

RESULTS

Three main themes and ten sub-themes were identified. The main themes concerned early presentation and identification in the workplace; reasonable adjustments for people with working age dementia; and the provision of information to raise awareness and facilitate informed choice. The evidence suggested that there is a lack of awareness about working age dementia and that this may impact negatively on employees. Guidance for employers offered suggestions for good practice.

CONCLUSIONS

Guidance for employers is increasingly available although it rarely refers to the evidence base. There is a need for future studies that explore the effectiveness of guidance and training initiatives for employers. Examples of good practice where employees with dementia have been well supported in the workplace and who have been able to leave the workforce with dignity, would be helpful.

What is the impact of dementia on occupational competence, occupational participation and occupational identity for people who experience onset of symptoms while in paid employment? A scoping review

BACKGROUND/AIM

Engagement in meaningful occupation, including paid work is considered an important determinant of health, impacted by injury or illness. Dementia is one neurodegenerative syndrome with potential to compromise capacity for remaining engaged in paid employment. In response to 'ageing' populations globally, policy shifts within developed economies are increasing workforce participation for those over 45 years and eligibility ages for retirement pensions. Dementia onset is not limited to 'older age', consequently an increased impact of dementia is likely for both older workers and those experiencing younger onset dementia. Therefore, identifying and addressing workforce participation issues confronting people with dementia is becoming increasingly important for occupational therapy practice.

METHOD

This scoping review draws on peer reviewed literature to explore the impact of dementia on workers across the three domains of occupational engagement: occupational competence; occupational participation; and occupational identity using the Model of Human Occupation (MOHO). International studies published in English including full-text translations between 2000 and 2017 were identified from an incremental search of electronic databases (Web of Science; Scopus; Proquest; MEDLINE; CINAHL; and Health Business Elite) and hand searched reference lists.

RESULTS

Six relevant papers were identified and retained for analysis, all reporting qualitative studies. Data were collated under the three domains of occupational engagement and further organised into emergent subcategories. While evidence was limited, person-centred approaches addressing dementia-related changes in occupational competence; workforce participation choices; and redefinition of occupational identity may mitigate negative experiences associated with transitioning from paid worker roles.

CONCLUSION

There is a significant need for further research exploring the impact of dementia on engagement in paid work. Occupational therapists have an important part to play in enabling access to person-centred interventions that promote continued engagement in meaningful occupational roles, including opportunities to extend workforce participation and engage in supported transitions to retirement.

Job Loss After Diagnosis of Early-Onset Dementia: A Matched Cohort Study

Early-onset dementia (EOD) affects the employment of patients and family members. To demonstrate how likely employees are to leave their jobs after an EOD diagnosis for themselves or a family member, we conducted a matched cohort study of 143 employees and 77 family members diagnosed with EOD using a claims database. We matched these participants to 5 controls each, and followed them for approximately 600 days. In the employee cohort, patients with EOD were more likely to leave their jobs than were controls (hazard ratio: 2.26). This suggests that healthcare providers should offer employment support to patients just after diagnosis.

Dementia in the workplace case study research: understanding the experiences of individuals, colleagues and managers

This article reports case study research which addresses the gap in knowledge about dementia in the workplace. Receiving a diagnosis of dementia whilst still in employment may have negative consequences for a person's identity, further compounded by loss of employment. This study is the first to explore the employment-related experiences of people with dementia and their employers to determine the potential for continued employment post-diagnosis. Sixteen case studies centred on a person with dementia who was still in employment or had left in the previous 18 months. Each involved interviews with the person with dementia, a family member and a workplace representative. This triangulation of the data promoted rigour, allowing the experiences to be viewed through a variety of lenses to build a clear picture of each situation. Thematic analysis was carried out and three themes were developed: (a) dementia as experienced in the workplace; (b) work keeps me well; and (c) wider impact of dementia in the workplace. These findings have the potential to initiate changes to policy and practice related to supporting employees with dementia. The implications of this research are multifaceted and need to be considered in terms of the individuals’ wellbeing, organisational support, as well as the wider theoretical, economic and societal consequences of supporting an employee with dementia.

The legal implications of dementia in the workplace: establishing a cross-disciplinary research agenda

Dementia is a growing issue in the United Kingdom (UK) with over 800,000 people affected. Of these people, in excess of 40,000 are aged under 65 years. Thus, a significant number of individuals may be experiencing symptoms of dementia while in employment. In addition, as working lives extend, the potential impact of dementia on the workplace could be substantial. However, to date, there has been little research on experiences of dementia in the workplace. The research that exists highlights the lack of support for workers with dementia. Dementia may be considered to be a disability under the Equality Act 2010. Therefore, the legislation potentially provides a framework for individuals to request that their employer make reasonable adjustments to support their continued employment. International human rights law is potentially another tool that could be utilised to obtain necessary adjustments. This paper argues that in developing the evidence base on workplace experiences of dementia, it is important that the legal framework be considered. This paper reviews the existing literature on dementia in the workplace and embeds this in the legislative framework in order to establish a cross-disciplinary research agenda. While the paper focuses on the UK legal context, the argument presented in the paper is still relevant to other national contexts.

Assistive technology for memory support in dementia

BACKGROUND

The sustained interest in electronic assistive technology in dementia care has been fuelled by the urgent need to develop useful approaches to help support people with dementia at home. Also the low costs and wide availability of electronic devices make it more feasible to use electronic devices for the benefit of disabled persons. Information Communication Technology (ICT) devices designed to support people with dementia are usually referred to as Assistive Technology (AT) or Electronic Assistive Technology (EAT). By using AT in this review we refer to electronic assistive devices. A range of AT devices has been developed to support people with dementia and their carers to manage their daily activities and to enhance safety, for example electronic pill boxes, picture phones, or mobile tracking devices. Many are commercially available. However, the usefulness and user-friendliness of these devices are often poorly evaluated. Although reviews of (electronic) memory aids do exist, a systematic review of studies focusing on the efficacy of AT for memory support in people with dementia is lacking. Such a review would guide people with dementia and their informal and professional carers in selecting appropriate AT devices.

OBJECTIVES

Primary objectiveTo assess the efficacy of AT for memory support in people with dementia in terms of daily performance of personal and instrumental activities of daily living (ADL), level of dependency, and admission to long-term care. Secondary objectiveTo assess the impact of AT on: users (autonomy, usefulness and user-friendliness, adoption of AT); cognitive function and neuropsychiatric symptoms; need for informal and formal care; perceived quality of life; informal carer burden, self-esteem and feelings of competence; formal carer work satisfaction, workload and feelings of competence; and adverse events.

SEARCH METHODS

We searched ALOIS, the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), on 10 November 2016. ALOIS is maintained by the Information Specialists of the CDCIG and contains studies in the areas of dementia prevention, dementia treatment and cognitive enhancement in healthy people. We also searched the following list of databases, adapting the search strategy as necessary: Centre for Reviews and Dissemination (CRD) Databases, up to May 2016; The Collection of Computer Science Bibliographies; DBLP Computer Science Bibliography; HCI Bibliography: Human-Computer Interaction Resources; and AgeInfo, all to June 2016; PiCarta; Inspec; Springer Link Lecture Notes; Social Care Online; and IEEE Computer Society Digital Library, all to October 2016; J-STAGE: Japan Science and Technology Information Aggregator, Electronic; and Networked Computer Science Technical Reference Library (NCSTRL), both to November 2016; Computing Research Repository (CoRR) up to December 2016; and OT seeker; and ADEAR, both to February 2017. In addition, we searched Google Scholar and OpenSIGLE for grey literature.

SELECTION CRITERIA

We intended to review randomised controlled trials (RCTs) and clustered randomised trials with blinded assessment of outcomes that evaluated an electronic assistive device used with the single aim of supporting memory function in people diagnosed with dementia. The control interventions could either be 'care (or treatment) as usual' or non-technological psychosocial interventions (including interventions that use non-electronic assistive devices) also specifically aimed at supporting memory. Outcome measures included activities of daily living, level of dependency, clinical and care-related outcomes (for example admission to long-term care), perceived quality of life and well-being, and adverse events resulting from the use of AT; as well as the effects of AT on carers.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened all titles and abstracts identified by the search.

MAIN RESULTS

We identified no studies which met the inclusion criteria.

AUTHORS' CONCLUSIONS

This review highlights the current lack of high-quality evidence to determine whether AT is effective in supporting people with dementia to manage their memory problems.

Measuring younger onset dementia: What the qualitative literature reveals about the 'lived experience' for patients and caregivers

BACKGROUND

The qualitative research on young onset dementia is providing insights about the 'lived experience' of patients and caregivers. However, findings from these studies have seldom been integrated into descriptive overviews. Our aim was to search the qualitative research, to integrate the qualitative findings, and offer an account of the lived experience for patients and caregivers.

METHOD

The search of the qualitative research formed part of a broader comprehensive literature search investigating salient measurement issues in the young onset dementia psychosocial research. Five electronic databases were searched (Medline, CINAHL, PsycINFO, Embase, the Cochrane Library) plus supplementary searching of reference sections and use of online search engines. We identified 23 qualitative articles.

RESULTS

In the pre-diagnostic period, patients experience changes in cognition and functioning but may be uncertain about changes and their significance. Caregivers may observe changes, think of explanations, and are important in instigating medical intervention. Obtaining a diagnosis may be a demanding process and the possibility of dementia may not be anticipated. In the post-diagnostic period, patients and caregivers use several strategies to cope and adjust. Patients can withdraw from established responsibilities while caregivers assume compensatory roles/duties. Patients perceive changes in their identity while caregivers perceive changes in the caregiver-patient relationship. Both can experience grief, isolation, and stigma.

DISCUSSION

The diagnosis of dementia elicits significant changes in thinking, emotion, and lifestyle that patients and caregivers are unlikely to be ready for. Both receive insufficient support or guidance in particular of a psychological nature on how to cope and adjust.

An exploration of the impact of younger-onset dementia on employment

This study explored the emergence of dementia in people who were still working. A qualitative life course approach was used to describe the experience from the onset of dementia-related symptoms to the time when the person left the workforce. The emergence of dementia at work for the participants in this study took the form of a slow transition that initially was not noticed by co-workers. It brought about subtle changes as the person became forgetful, disorganised, made mistakes and was slower. Over time the person’s job performance continued to deteriorate and others at the workplace started to realise that there was a problem. Some were seen to be poor workers and so experienced difficulties with supervisors and co-workers. Others encountered difficulties managing changing relationships at work and negotiating the complex world of the workplace. Few were able to continue working beyond their diagnosis, and several raised concerns about the lack of opportunities for people who develop dementia while still employed. Given the greater participation of older people in the workforce, findings highlight the importance of identifying and supporting workers with declining cognitive function.

Investigating poor insight in Alzheimer’s disease

Persons with Alzheimer’s disease (AD) often seem to have a poor insight into the functional deficits brought about by the dementing process. There are many indications that preserved insight into deficits in dementia is of advantage to a person with AD. Various research approaches have been adopted to investigate poor insight related to AD. The purpose of this article was to present various research approaches for investigating poor insight into deficits in AD. The study is based on a literature survey. The findings show that concept of poor insight has been investigated in detail from different perspectives. Each one of the perspectives found, the neuropsychological, the psychological and the socio-psychological, has its merits, but none of them has yet led to study results that make us fully understand what poor insight implies and involves. We need integrated knowledge from the different perspectives, and in multidisciplinary research settings we believe that such knowledge could be developed.

Managing Changes in Everyday Occupations: The Experience of Persons with Alzheimer's Disease

The aim of this study was to uncover how people with dementia respond to the problems and changes they experience in everyday occupations. Seven participants with dementia were included. Data were collected by means of repeated interviews and observations that focused on the person's experiences of competence and management in everyday occupations. The analysis was carried out from within a phenomenological perspective and resulted in a structure describing management strategies. It was concluded that the participants used a wide variety of strategies. Some strategies were directed toward managing the altered conditions caused by the disease while others served the purpose of responding to the occupational problems of everyday life. The latter strategies were of three types based mainly on environment, habituation, and cognition. Overall, the implicit and explicit cognitive awareness underpinning many strategies seems to call for great caution when assuming that people with dementia soon lose their awareness of disability.

Meanings and Motives for Engagement in Self-Chosen Daily Life Occupations among Individuals with Alzheimer's Disease

The aim of this study was to uncover and describe the meanings and motives for engagement in self-chosen daily life occupations for elderly individuals with Alzheimer's disease dwelling in the community. Six participants with Alzheimer's disease were included. Data were collected through repeated interviews and observations focusing on their motives for their self-chosen occupational engagement and the significance of the daily occupations. The analysis used a qualitative comparative and interpretative method. The findings show that the participants' occupations supported their ordinary pattern of everyday life and provided them with an opportunity to be in a coherent context. The occupations also allowed them to experience and communicate autonomy and certain characteristics of their identity and provided them with a private sphere. The findings revealed certain crucial but double-edged environmental keys to occupation. By identifying and supporting everyday occupations with personal meaning and value, therapists and caregivers may contribute to the well-being of individuals with Alzheimer's disease living in their own homes.

The Lived Experience of Memory Impairment in Daily Occupation after Acquired Brain Injury

The objective of this study was to identify what characterized the lived experience of memory impairment in daily occupations during the first year after acquired brain injury. Four participants were interviewed on four occasions during the year after the brain injury. The data were collected and analyzed using the Empirical Phenomenological Psychological method. The findings revealed four main characteristics that described the individual's experiences during the year of rehabilitation: a chaotic life-world, struggling for coherent doing in new contexts, conscious strategies in new contexts, and achieving new habits. After the brain injury, the life-world changed from a taken-for-granted existence to a chaotic world that was difficult to understand. The routine performance of daily activities and the habit patterns had broken down, so it was mostly the familiar activities that were already integrated in the “habit-body” that enabled coherent doings in everyday life during the year. The findings contribute to an understanding of how to use familiar and meaningful occupations as a therapeutic medium in the rehabilitation of clients with memory impairment following acquired brain injury.

Caregivers' Self-Initiated Support toward Their Partners with Dementia When Performing an Everyday Occupation Together at Home

The aim of this study was to identify the support caregivers provide by their own initiative when performing an everyday occupation together with their partner who has dementia. This is to identify what type of self-initiated caregiver support enhances or limits the performance of the person with dementia. Thirty cohabitating couples participated. One of the spouses in each couple was the primary caregiver for a partner with mild to moderate dementia. Observational data were collected in the participants' homes, where each couple was asked to prepare afternoon tea together. The performances were documented by video and supplementary field notes. Data were analyzed using a qualitative comparative approach. The results of the analyses identified two major themes related to support the caregivers provided: provision of a supportive working climate and provision of practical support. A third theme was related to negative aspects of caregiver support. The results of this study have implications for how occupational therapists and caregivers in dementia care can support and guide primary caregivers in their homes.

'Nobody would say that it is Alzheimer's or dementia at this age': Family adjustment following a diagnosis of early-onset dementia

OBJECTIVES

Family interaction and intergenerational dynamics have been known to influence the efficacy of therapeutic interventions and as such, the understanding of such dynamics in the experience of transitions can assist in strengthening the support provided to families living with such diagnoses. As such, the aims and objectives of this work were to develop a deeper understanding of family transition in early-onset dementia and to construct a representative model of this experience.

METHOD

This qualitative study used an 'initial-and-follow-up' interview design with semi-structured in-depth interviews in participants' homes. A framework approach to qualitative data analysis was used in order to identify important points of transition in the family experience of early-onset dementia and how families frame and respond to their own health expectations.

RESULTS

Nine families provided written informed consent to participate in the study. The nine participating families were made up of 20 participants, including nine spousal pairs and two young adult children. Each family participated in two research interviews in their individual homes. Four major themes emerged from the data: Diagnosis; Finances; Relationships; and Meaningful Activity.

CONCLUSION

Transitions experienced by families in early-onset dementia can be significantly impacted by the opportunity and availability of meaningful activity and/or a purposeful role. Not only does this activity benefit both the person with dementia and their family, but also supports much needed home and community living for people with dementia, as demonstrated by predicted future bed shortages in Canadian hospitals and long term care facilities.

Dementia in the workplace: a review

Purpose

– Recent changes affecting state pension age, and earlier diagnosis, will result in more people with dementia in employment. The purpose of this paper is to establish the nature of support that would enable/enables people with dementia or mild cognitive impairment to continue employment post diagnosis.

Design/methodology/approach

– An integrative review was carried out supported by information derived from a thematic analysis of data from interviews with seven relatives supporting a younger person with dementia and one person with dementia.

Findings

– Six papers were identified for inclusion in the review. Findings from the published papers and interviews indicated that work is a significant issue for people with dementia highlighting problems with job retention, work performance and the impact of diagnosis.

Research limitations/implications

– The review highlighted a dearth of high-quality research in the area. Although employment was not the main focus of the interviews, the extracts highlight some of the challenges that face people who develop dementia while of working age, their families, and employers.

Practical implications

– Vocational rehabilitation is primarily carried out by allied health professionals; however, there is a lack of research evidence relating to people with dementia in the workplace. Further research is needed in order to inform future practice.

Social implications

– Loss of employment deprives families of financial security and employers of a skilled employee.

Originality/value

– This is the first review to focus on dementia in employment, providing a starting point on which to base future research in this area.

'It's nice to have something to do': early-onset dementia and maintaining purposeful activity

As the global focus on dementia care increases due to the demand on health, social, legal and financial services, it is imperative to further understand the experience of those living with a diagnosis of dementia. There is a particular lack of research focused on younger people (under the age of 65 years) with dementia and virtually none focuses on the experience of the family unit. The literature suggests that periods of transition place significant stressors on families living with dementia. One such transition is the transition out of perceived purposeful activity, be this employment or voluntary work. This transition was explored during the course of a qualitative repeated interview study with younger people with dementia and their families. Nine families (20 participants) took part in semi-structured research interviews that were transcribed and analyzed using a Framework approach to qualitative analysis. Meaningful Activity emerged as a major theme through this analysis. Two subthemes also emerged: (1) the traumatic cessation of work; and (2) the need for purposeful activity. These themes have significant clinical implications as maintaining a purposeful role through high-quality, age-specific dementia services may decrease the direct and indirect costs of dementia to global economies.

What are the experiences of people with dementia in employment?

Statistics show that an increase in the statutory retirement age in the UK will mean that many more people will develop a dementia while still in employment. A review of the literature confirmed that there are no existing studies in the UK which examine this issue in any detail. The aim of this study was to investigate the experiences of people who develop a dementia while still in employment and to understand how they make sense of these experiences; therefore a qualitative explorative inquiry based on an Interpretive Phenomenological Analysis methodology was used. Interviews with five people who had developed a dementia while still in employment were carried out, with ages ranging from 58 to 74 years. Interview transcripts were analysed and four super-ordinate themes were identified: the realization that something is wrong; managing the situation in the workplace; trying to make sense of change; and coming to terms with retirement or unemployment. The results showed that people who develop a dementia while still in employment do not always receive the 'reasonable adjustments' in the workplace to which they are entitled under the Equality Act (2010). Some of the participants felt that they were poorly treated by their workplace and described some distressing experiences. The study highlights the need for more effective specialized advice and support regarding employment issues and more research into the numbers of people in the UK that are affected by this issue.

Subjective experiences of younger people with dementia and their families: implications for UK research, policy and practice

Young-onset dementia (dementia in people under 65 years of age) remains an under-researched area of dementia care. As populations age in industrialized countries, dementia is set to increase: this includes dementias in younger people. Current estimates suggest there are over 15 000 younger people living with dementia in the UK, whilst dedicated services and research in this area remain limited. Younger people may be affected by rarer forms of dementia that can create various kinds of impairment in the individual. For example, as Boxer and Miller report, although memory can be affected, people with conditions such as frontotemporal dementia can present initially with personality changes as the primary symptom. Younger people may also have more difficulties with visuospatial and semantic tasks when compared with an person, and there are likely to be personal and societal implications for the entire family.

The use of everyday technology by people with dementia living alone: mapping out the difficulties

While the technological development available to society is taking quantum leaps, we have little knowledge of how people with mild dementia manage to cope with familiar technology at home, such as television and electronic household machines, or new technology, such as remote controls, cell phones and computers. As this technology represents a potential problem area, the aim of this qualitative, exploratory study was to identify and characterize difficulties with and hindrances to using everyday technology, as they appeared in data, for persons with early stage dementia. Eight participants with dementia were included in an extensive data collection consisting of repeated interviews and observations made in the home; the data were analyzed adopting a constant comparative approach. The results exhibit a taxonomy of difficulties in four domains, encompassing conditions that interfere with the use of the technology, deficiencies in knowledge and in the communication between users and their technology, and limitations in the use of instructions. Typically, difficulties appeared in complex combinations. They arose when familiar technology was being used, and not only when new technology was to be used. This raised concerns about the need these people have for support in home and in society. Further research is needed to validate the findings.

Telephone use among noninstitutionalized persons with dementia living alone: mapping out difficulties and response strategies

The aim of this study was to map out and describe difficulties and response strategies in telephone use among elderly, noninstitutionalized persons with dementia living alone. To obtain explorative data, interviews and observations in the homes were undertaken with 10 participants diagnosed with dementia. The participants were observed when showing their telephones, calling a well-known number, responding to a request previously sent by letter to make a telephone call, and finding a number in the telephone directories. The data were analysed using a comparative approach, and resulted in descriptive categories. The participants' difficulties were categorized as difficulty in 'knowing what', 'knowing where', 'knowing how' and overcoming motor, perceptual, verbal and environmental obstacles. In responding to these, they used a variety of environmentally related strategies such as using perception or habits and habitual places, verbalizing aloud, seeking help from others, and adjusting the physical environment. They also used a few cognitively related strategies such as repeating and stopping and reflecting. Overall, difficulties were frequent and common, and the effectiveness of the strategies was questionable. The results indicate that it might be unrealistic to assume that elderly persons with symptoms of dementia who live alone are able to satisfactorily use the telephone for safety, communication and participation in society.