A note on whether spousal caregivers try to control their environment or themselves

Meaningful activities for improving the wellbeing of people with dementia: beyond mere pleasure to meeting fundamental psychological needs

AIMS

Dementia is being increasingly recognised as a major public health issue for our ageing populations. A critical aspect of supporting people with dementia is facilitating their participation in meaningful activities. However, research to date has not drawn on theories of ageing from developmental psychology that would help undergird the importance of such meaningful activity. For the first time, we connect existing activity provision for people with dementia with developmental psychology theories of ageing.

METHOD

We reviewed the literature in two stages: first, we narratively searched the literature to demonstrate the relevance of psychological theories of ageing for provision of meaningful activities for people with dementia, and in particular focused on stage-based theories of adult development (Carl Jung and Erik Erikson), gerotranscendence (Tornstam), selective optimisation with compensation (Baltes and Baltes), and optimisation in primary and secondary control (Heckhausen and Schulz). Second, we systematically searched PubMed and PsycINFO for studies with people with dementia that made use of the aforementioned theories.

RESULTS

The narrative review highlights that activity provision for people with dementia goes beyond mere pleasure to meeting fundamental psychological needs. More specifically, that life review therapy and life story work address the need for life review; spiritual/religious activities address the need for death preparation; intergenerational activities address the need for intergenerational relationships; re-acquaintance with previously conducted leisure activities addresses the need for a sense of control and to achieve life goals; and pursuit of new leisure activities addresses the need to be creative. The systematic searches identified two studies that demonstrated the utility of applying Erikson's theory of psychosocial development to dementia care.

CONCLUSION

We argue for the importance of activity provision for people with dementia to help promote wellbeing among an increasing proportion of older people.

Secondary control reviewed and defined

Conclusions about secondary control have been hindered by researchers' disparate interpretations of the construct. The current review offers a definition that reflects commonality among researchers and the spirit of the original article (F. Rothbaum, J. R. Weisz, & S. S. Snyder, 1982): Secondary control refers to the process by which people adjust some aspect of the self and accept circumstances as they are. The authors also identify a "fit versus control" dimension, along which secondary control research can be classified and reviewed. The authors conclude that fit-focused secondary control is adaptive for coping, is relatively preferred in interdependent cultural contexts, and may serve the motivation for relatedness. Control-focused definitions lead to different interpretations of the function and cultural nature of secondary control. The proposed definition and dimension should enable researchers to articulate assumptions about the function and correlates of secondary control.