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Arjama AL. Ethical issues in long-term care settings: Care workers' lived experiences. Nurs Ethics 2024; 31:213-226. [PMID: 37541651 PMCID: PMC11181730 DOI: 10.1177/09697330231191277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
BACKGROUND Professional care workers face ethical issues in long-term care settings (LTCS) for older adults. They need to be independent and responsible, despite limited resources, a shortage of skilled professionals, global and societal changes, and the negative reputation of LTCS work. RESEARCH AIM Our aim was to describe the care workers' lived experiences of ethical issues. The findings can be used to gain new perspectives and to guide decision-making to improve the quality of care, occupational well-being and nursing education. RESEARCH DESIGN Focus group interviews were analyzed using a hermeneutic-phenomenological method. The analysis comprised three steps: naïve reading, structural analysis, and comprehensive understanding. PARTICIPANTS AND RESEARCH CONTEXT We randomly sampled LTCS service providers in Finland and 53 care workers with different educational backgrounds from seven organizations participated in focus group interviews in 2021. ETHICAL CONSIDERATIONS This was a sensitive study, which was connected to the participants' individual views of the world, professional ethics and social and health care legislation. The participants' provided informed consent and their anonymity was guaranteed. FINDINGS Care workers spoke about their lived experiences of ethical issues in an emotional way, using practical examples. They talked about how they were experts at caring and advocating for residents, balanced the responsibilities of their different roles, and defended their work to the wider society. The care workers said that ethical aspects of their work were too difficult to solve on their own. There were elements of their working environment and practices that caused unnecessary strain and they needed the commitment of managers, organizations, and society to solve ethical issues in LTCS. CONCLUSIONS Ethical issues were related to the well-being of both residents and care workers and reflected both internal and external pressures. Some issues could not be resolved by individuals and needed input from managers, organizations, and society.
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Alexander CM, Martyr A, Savage SA, Morris RG, Clare L. Measuring Awareness in People With Dementia: Results of a Systematic Scoping Review. J Geriatr Psychiatry Neurol 2021; 34:335-348. [PMID: 32400259 PMCID: PMC8326902 DOI: 10.1177/0891988720924717] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Awareness of the diagnosis or related changes in functioning varies in people with dementia (PwD), with implications for the well-being of PwD and their carers. Measuring awareness in a clinical setting could facilitate tailored support and optimize involvement in personal health and care decisions. This scoping review aimed to identify validated methods of assessing awareness in dementia and appraise their clinical utility. METHOD A systematic search was conducted of English-language publications that measured awareness in PwD, in 6 electronic databases. Search terms included dement*, Alzheimer*, Pick disease, and awareness, unawareness, anosognosia, insight, denial, metacognit*, or discrepanc*. RESULTS We screened 30,634 articles, finding 345 articles that met our inclusion criteria. We identified 76 measures, most commonly using a discrepancy questionnaire comparing evaluations of function by PwD and an informant. There were 30 awareness measures developed and validated for use in dementia populations but few designed for general clinical use. CONCLUSIONS Although we found a range of clinical indications for measuring awareness, there were few studies investigating clinical applications and few tools designed for clinical purposes. Further investigation and development of a person-centered tool could facilitate health and care choices in mild-to-moderate dementia.
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Affiliation(s)
- Catherine M. Alexander
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom,Catherine M. Alexander, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, United Kingdom.
| | - Anthony Martyr
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom
| | - Sharon A. Savage
- Psychology Department, University of Exeter, Washington Singer Laboratories, Streatham Campus, Exeter, United Kingdom
| | - Robin G. Morris
- King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Linda Clare
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom
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Shim YS, Park KH, Chen C, Dominguez JC, Kang K, Kim HJ, Hong Z, Lin YT, Chu LW, Jung S, Kim S. Caregiving, care burden and awareness of caregivers and patients with dementia in Asian locations: a secondary analysis. BMC Geriatr 2021; 21:230. [PMID: 33827446 PMCID: PMC8028783 DOI: 10.1186/s12877-021-02178-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study investigated the differences in caregiver activity, caregiver burden, and awareness of both caregivers and patients with Alzheimer’s disease (AD) across different Asian locations. Methods This was a secondary analysis of a multi-national cohort study that aimed to assess caregiver activity and caregiver burden using the Caregiver Activity Scale (CAS) and Zarit Burden Interview (ZBI), respectively. Patients’ awareness of their dementia diagnosis was assessed by asking the following yes/no question: “Do you have dementia?” Caregivers’ awareness of the patient’s dementia diagnosis was assessed by asking the following yes/no question: “Does your patient have dementia?” Results In total, 524 caregivers of patients with AD from China, Hong Kong, South Korea, the Philippines, Singapore, Thailand, and Taiwan participated. The CAS and ZBI score were significantly different across most locations (p < 0.001 and p = 0.033, respectively). Overall, 56.6% of caregivers and 37.5% of patients had awareness of the dementia diagnosis, and the proportion of patients and caregivers with awareness were also different between each location (all, p < 0.001). Conclusions Caregiving, caregiver burden, and the awareness of caregivers and patients were different across many Asian locations. With understanding of cultural differences, further public education on dementia could help increase the awareness of patients and caregivers and reduce caregiver burden. Trial registration ClinicalTrials.gov, NCT02262975. Registered 13 October 2014,
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Affiliation(s)
- Yong S Shim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kee Hyung Park
- Department of Neurology, College of Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Christopher Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Kyunghun Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hee-Jin Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Zhen Hong
- Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yu-Te Lin
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Leung-Wing Chu
- Queen Mary Hospital, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - San Jung
- Department of Neurology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine & Clinical Neuroscience Center, Seoul National University Bundang Hospital, 582, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Seoul, Republic of Korea.
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Novel Alzheimer's disease subtypes identified using a data and knowledge driven strategy. Sci Rep 2020; 10:1327. [PMID: 31992745 PMCID: PMC6987140 DOI: 10.1038/s41598-020-57785-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/16/2019] [Indexed: 01/08/2023] Open
Abstract
The population of adults with Alzheimer’s disease (AD) varies in needs and outcomes. The heterogeneity of current AD diagnostic subgroups impedes the use of data analytics in clinical trial design and translation of findings into improved care. The purpose of this project was to define more clinically-homogeneous groups of AD patients and link clinical characteristics with biological markers. We used an innovative big data analysis strategy, the 3C strategy, that incorporates medical knowledge into the data analysis process. A large set of preprocessed AD Neuroimaging Initiative (ADNI) data was analyzed with 3C. The data analysis yielded 6 new disease subtypes, which differ from the assigned diagnosis types and present different patterns of clinical measures and potential biomarkers. Two of the subtypes, “Anosognosia dementia” and “Insightful dementia”, differentiate between severe participants based on clinical characteristics and biomarkers. The “Uncompensated mild cognitive impairment (MCI)” subtype, demonstrates clinical, demographic and imaging differences from the “Affective MCI” subtype. Differences were also observed between the “Worried Well” and “Healthy” clusters. The use of data-driven analysis yielded sub-phenotypic clinical clusters that go beyond current diagnoses and are associated with biomarkers. Such homogenous sub-groups can potentially form the basis for enhancement of brain medicine research.
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Bregman N, Kavé G, Shiner T, Biran I. Dissociation in awareness of memory and language decline in Alzheimer's disease. Int J Geriatr Psychiatry 2019; 34:548-554. [PMID: 30548691 DOI: 10.1002/gps.5049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/09/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The aim of this study was to examine awareness of decline in memory and in language in individuals with Alzheimer's disease (AD), by comparing participant and informant ratings, as well as these ratings and actual test performance. METHODS We analyzed data from 149 individuals with AD enrolled in the Alzheimer's Disease Neuroimaging Initiative (ADNI) who filled the Everyday Cognition questionnaire and performed memory and language tasks. RESULTS Participants provided significantly lower assessments of decline than did informants for both memory and language. There was a negative association between informant ratings and memory test scores but no association between participant ratings and memory test scores. Both participant and informant ratings correlated negatively with performance on the language tests. Informant, but not participant, ratings contributed to the prediction of one memory variable beyond demographic factors. Participant ratings contributed to the prediction of language scores beyond demographic factors more than did informant ratings. CONCLUSIONS The findings reflect better awareness of decline in language than of decline in memory in individuals with AD.
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Affiliation(s)
- Noa Bregman
- Center for Memory and Attention Disorders, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gitit Kavé
- Center for Memory and Attention Disorders, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Education and Psychology, The Open University, Ra'anana, Israel
| | - Tamara Shiner
- Center for Memory and Attention Disorders, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Iftah Biran
- Center for Memory and Attention Disorders, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Monfort E, Gandit M, Poulet C, Quillion-Dupré L, Boudin B, Couturier P. Perception of domestic risks among carers for dependent older persons. Psychogeriatrics 2018; 18:371-378. [PMID: 29987862 DOI: 10.1111/psyg.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/27/2017] [Accepted: 02/03/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite growing interest for home care, little evidence exists on the perception of domestic risk among carers for dependent older persons. This study aims to characterize the risks to which carers of aging dependent individuals are exposed, and to determine whether these risk dimensions are predictive for effective support, for burden, and for psychological distress. METHODS Seventy care partners were questioned about the risk situations identified at the homes of the old people they care for, about the burden they felt in their role, and about their feelings of psychological distress. Securing was evaluated by means of sensibility measures, and overprotection was evaluated by means of specificity measures. RESULTS Risk rates were high for loneliness of the old people, wandering, burns, and unsatisfactory health monitoring. There was very little overlap between identification of the risks and implementation of solutions by the caregiver, except for the risks that involved heat. The distinction between accurate securing and overprotection is especially important, because the burden of care partners was linked to uncontrolled domestic risks. CONCLUSION Typologies of reactions to risk, characterized by a signal detection approach, could contribute to a better understanding of the situations experienced by care partners, especially situations of neglect and of overprotection.
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Affiliation(s)
- Emmanuel Monfort
- Grenoble Psychology Laboratory (LIP/PC2S), University Grenoble Alpes, Grenoble Cedex, France
| | - Marc Gandit
- Grenoble Psychology Laboratory (LIP/PC2S), University Grenoble Alpes, Grenoble Cedex, France
| | - Caroline Poulet
- Grenoble Psychology Laboratory (LIP/PC2S), University Grenoble Alpes, Grenoble Cedex, France
| | - Lisa Quillion-Dupré
- Autonomy Gerontology E-health Imagery and Society Laboratory (AGEIS), University of Grenoble Alpes, Grenoble Cedex, France
| | - Bertrand Boudin
- Grenoble Psychology Laboratory (LIP/PC2S), University Grenoble Alpes, Grenoble Cedex, France
| | - Pascal Couturier
- Department of Geriatric Medicine - ThEMAS TIMC-IMAG, Grenoble Alpes University Hospital, Grenoble Cedex, France
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McWilliams L, Farrell C, Keady J, Swarbrick C, Burgess L, Grande G, Bellhouse S, Yorke J. Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study. BMJ Open 2018; 8:e020250. [PMID: 29654025 PMCID: PMC5898327 DOI: 10.1136/bmjopen-2017-020250] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. DESIGN Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. SETTING Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. PARTICIPANTS Purposeful sample of 10 patients with a diagnosis of cancer-dementia, informal caregivers (n=9) and oncology HCPs (n=12). RESULTS Four themes were identified: (1) leading to the initial consultation-HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information-informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care-patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment-there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. CONCLUSIONS Although patients with cancer-dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway.
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Affiliation(s)
- Lorna McWilliams
- Christie Patient Centred Research, School of Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Carole Farrell
- Christie Patient Centred Research, School of Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Keady
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Caroline Swarbrick
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Lorraine Burgess
- Psycho-Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Sarah Bellhouse
- Christie Patient Centred Research, School of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Janelle Yorke
- Christie Patient Centred Research, School of Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Cooney A, O'Shea E. The impact of life story work on person-centred care for people with dementia living in long-stay care settings in Ireland. DEMENTIA 2018; 18:2731-2746. [PMID: 29411663 DOI: 10.1177/1471301218756123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The potential of life story work to add quality to dementia care is widely acknowledged. Whether this potential is always realised in practice and under what circumstances is less clear. This paper explores whether knowing the person’s life story enhances healthcare professionals’ understanding of the person with dementia and whether this understanding impacts on the person’s care. In-depth interviews were conducted with 11 registered nurses and 12 healthcare assistants who had used life story work with people with dementia living in long-stay care settings. Data were analysed using the constant comparative technique. Engaging in life story work enabled staff to see the person behind the dementia. Understanding (as opposed to knowing) the person with dementia’s life story changed staff’s thinking on what is important when delivering care to people with dementia, with staff giving concrete examples of changes in how they delivered care to the person with dementia and what they considered important when delivering that care. It was concluded that life story work can facilitate a shift to person centred dementia care but how it is implemented matters if this outcome is to be achieved.
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Affiliation(s)
- Adeline Cooney
- Centre for Teaching & Learning, Maynooth University, Ireland
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia, National University of Ireland Galway, Ireland
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Doron II, Werner P, Spanier B, Lazar O. Court rulings involving individuals with dementia in Israel: A qualitative perspective. DEMENTIA 2018; 18:2576-2595. [PMID: 29385818 DOI: 10.1177/1471301217752150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Individuals with dementia may appear before the courts in different roles. Despite the growing interest in the rights of older persons with dementia, relatively little empirical data exist regarding their actual interactions and experiences in court. Methods This study used a qualitative, textual analysis methodology. A total of 281 Israeli legal court cases, which addressed issues relating to dementia, were analyzed. Results Four key themes were found in the legal texts: (1) The legal construction of dementia and its relationships to old age; (2) The importance of procedural justice; (3) The implications and outcomes of the legal process; and (4) The legal implications to the society as a whole. Conclusions The legal narratives, which surround legal cases that deal with dementia in Israel, reveal an internal tension between stigmatic and anti-stigmatic narratives. This complex reality raises the need for further research and for a clearer judicial policy.
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Affiliation(s)
- Israel Issi Doron
- The Center for Research and Study of Aging & the Department of Gerontology, University of Haifa, Israel
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Israel
| | - Benny Spanier
- The Center for Research and Study of Aging, University of Haifa, Israel
| | - Ori Lazar
- Faculty of Law, University of Haifa, Israel
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McCusker EA, Loy CT. Huntington Disease: The Complexities of Making and Disclosing a Clinical Diagnosis After Premanifest Genetic Testing. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:467. [PMID: 28975045 PMCID: PMC5623754 DOI: 10.7916/d8pk0tdd] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/24/2017] [Indexed: 12/01/2022]
Abstract
The management of patients and families affected by Huntington disease (HD) is complicated by several factors, both practical and ethical. It can be difficult to determine the onset of clinically manifest HD (mHD). In addition, it can be challenging to decide when to disclose the diagnosis to the affected individual. Firstly, the features of HD, an incurable, inherited, neurocognitive disorder that often manifests in young adulthood, influence how the person presents and accepts a diagnosis. Secondly, a positive genetic test for HD may result in a genetic diagnosis, sometimes years before the development of clinical features and the diagnosis of mHD. Thirdly, observational studies of unaffected gene expansion carriers documented HD manifestations up to 10 years before the typical presentation for diagnosis. These developments may permit earlier genetic diagnosis and information regarding the patient’s likely status with respect to the development of clinical disease. Making the genetic diagnosis of HD and providing information regarding disease status, earlier rather than later, respects the person’s right to know and preserves honesty in the doctor/patient relationship. Conversely, delaying the diagnosis respects the right not to know, avoids potential discrimination, and permits the person to live a “normal” life for longer, in the context of a disease without cure. This discussion has implications for other inherited and neurocognitive disorders.
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Affiliation(s)
- Elizabeth A McCusker
- Huntington Disease Service, Neurology Department, Westmead Hopsital, Sydney, Australia.,University of Sydney Medical School, Sydney, Australia
| | - Clement T Loy
- Sydney School of Public Healththe University of Sydney, Sydney, Australia.,Garvan Institute of Medical Research, Sydney, Australia
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Delineau VMEB, Schultz RR. Dementia and legal determination of capacity. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:349-353. [PMID: 28658403 DOI: 10.1590/0004-282x20170061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the legal capacity and guardianship proceedings in patients diagnosed with dementia. METHODS Ninety-seven patients diagnosed with dementia and seen at a tertiary hospital were evaluated. RESULTS Of these 97 patients, 60 (62%) were female. The mean age of the patients was 77.9 years; average schooling was 5.5 years. The main diagnosis was Alzheimer's disease (73%): 16 patients were at a mild stage, eight at a moderate stage and 73 at an advanced stage of dementia. Only 28 patients had been legally declared incapable. CONCLUSION The large numbers of patients at an advanced stage of dementia, and the relatively few patients legally declared incapable show that legal issues in dementia are problematic.
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Affiliation(s)
- Valeska Maria Eboli Bello Delineau
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Setor de Neurologia do Comportamento, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
| | - Rodrigo Rizek Schultz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Setor de Neurologia do Comportamento, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
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Abstract
BACKGROUND Individuals with dementia may appear before the court in different roles: as victims, as witnesses, and as those standing up for their rights. While there is growing interest in the rights of older persons with dementia, relatively little empirical data exists regarding their actual interactions in courts. Therefore, the goal of this study was to empirically map this legal terrain. METHODS This study used a descriptive quantitative method. A computerized search of a national legal database limited to the period 2004-2014 and a screening process for the results were used to establish a sample of 280 court rulings that directly addressed dementia. All cases were analyzed and categorized into the following four criteria groups: characteristics of the person with dementia; characteristics of the legal procedure; the legal substance of the case; and the legal outcome. RESULTS The majority of cases involved a single, very-elderly (i.e. over 80 years) woman, living in the community, with unspecified dementia. The majority of cases were heard and decided in lower level courts, addressing a broad range of primarily non-criminal legal issues. Finally, in the majority of non-criminal cases, the person with dementia was found to be legally capable, whereas in the majority of criminal cases, the person with dementia was found incapable. CONCLUSIONS The legal needs and rights of persons with dementia are much broader than issues of legal capacity or social protection. Deeper knowledge and more research is needed in order to fully understand the contexts in which dementia is constructed under the law.
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Escalante MAL, Tsekleves E, Bingley A, Gradinar A. ‘Ageing Playfully’: a story of forgetting and remembering. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/24735132.2017.1295529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maria A. Luján Escalante
- The Creative Exchange Hub, Lancaster Institute for the Contemporary arts (LICA), Lancaster University, Lancaster, UK
| | | | - Amanda Bingley
- Faculty of Health & Medicine, Division of Health Research, Lancaster University, Lancaster, UK
| | - Adrian Gradinar
- The Creative Exchange Hub, Lancaster Institute for the Contemporary arts (LICA), Lancaster University, Lancaster, UK
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Parrao T, Brockman S, Bucks RS, Bruce DG, Davis WA, Hatch KK, Leavy TL, Axten CA, Starkstein SE. The Structured Interview for Insight and Judgment in Dementia: Development and validation of a new instrument to assess awareness in patients with dementia. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2016; 7:24-32. [PMID: 28203628 PMCID: PMC5295621 DOI: 10.1016/j.dadm.2016.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Poor insight about their cognitive and functional deficits is highly prevalent in patients with Alzheimer's disease (AD); however, there is a lack of reliable, valid instrumentation to measure this construct. The aim of this study was to develop and validate a semistructured interview to assess insight and judgment in patients with AD and to provide information regarding the assessment of competency and risk in this population. METHODS We validated the Structured Clinical Interview for Insight and Judgment in Dementia (SIJID) in a consecutive series of 124 patients with probable AD. The following psychometric properties were evaluated: internal consistency, test-retest reliability, interrater reliability, and convergent and predictive validity. RESULTS The SIJID demonstrated high test-retest, interrater reliability and also showed strong discriminant and convergent validity. It showed good predictive validity based on 1-year follow-up information of the patient's clinical outcomes, with a significant association between higher SIJID total scores at baseline, and more severe neuropsychiatric symptoms and more severe caregiver distress at follow-up. Moreover, higher scores of dangerous behaviors at baseline were significantly correlated with a higher frequency of hospitalization and placement in residential care 1 year later. CONCLUSION The SIJID is a reliable and valid instrument to assess insight and judgment in patients with AD and is a valuable tool for assessing presence and severity of dangerous behaviors, determining risk, and providing critical information for the assessment of competency.
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Affiliation(s)
- Teresa Parrao
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Simone Brockman
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Romola S. Bucks
- School of Psychology, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - David G. Bruce
- School of Medicine and Pharmacology, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Wendy A. Davis
- School of Medicine and Pharmacology, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Katherine K. Hatch
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Tammy L. Leavy
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Christine A.P. Axten
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Sergio E. Starkstein
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
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Hynes SM, Field B, Ledgerd R, Swinson T, Wenborn J, di Bona L, Moniz-Cook E, Poland F, Orrell M. Exploring the need for a new UK occupational therapy intervention for people with dementia and family carers: Community Occupational Therapy in Dementia (COTiD). A focus group study. Aging Ment Health 2016; 20:762-9. [PMID: 25929167 PMCID: PMC9122617 DOI: 10.1080/13607863.2015.1037243] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In the Netherlands, Graff et al. found Community Occupational Therapy in Dementia (COTiD) demonstrated benefits to people with dementia and family carers. In this study, focus groups took place with people with dementia and family carers to explore how to make COTiD relevant to the UK context. METHOD Six focus groups (three with people living with dementia (n = 18) and three with family carers (n = 21)) took place. Participants were asked for their impressions of the intervention, the extent to which it could meet their needs, and what modifications were needed. Audio-recordings of the groups were transcribed and analysed. RESULTS Three key themes emerged covering 'loss and living with dementia', 'what helped us', and 'consistency and continuity'. People with dementia and family carers spoke about the impact of their diagnosis on them and their family and what strategies helped. Issues such as timing, follow-up, and the importance of an early intervention in preventing crises were highlighted. There was some concern over the length of the intervention and the disruption it might cause to current schedules. CONCLUSION Overall, participants were optimistic about COTiD being used in the United Kingdom if it was to be introduced in a flexible and timely manner, incorporating the needs and existing strategies of the person with dementia. These outcomes have led to changes, such as incorporating more flexibility into COTiD, being made to the intervention prior to its implementation in the United Kingdom.
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Affiliation(s)
- Sinéad M Hynes
- Occupational Science and Occupational Therapy Department, Faculty of Medicine, University of British Columbia, Vancouver, Canada,Corresponding author.
| | - Becky Field
- Rehabilitation and Assistive Technology Group, Health Services Research, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, United Kingdom
| | - Ritchard Ledgerd
- Dementia Care Research Centre, Research & Development Department, North East London NHS Foundation Trust, Essex, United Kingdom
| | - Thomas Swinson
- Dementia Care Research Centre, Research & Development Department, North East London NHS Foundation Trust, Essex, United Kingdom
| | - Jennifer Wenborn
- Dementia Care Research Centre, Research & Development Department, North East London NHS Foundation Trust, Essex, United Kingdom
| | - Laura di Bona
- Rehabilitation and Assistive Technology Group, Health Services Research, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, United Kingdom
| | - Esme Moniz-Cook
- Centre of Dementia Research and Practice, University of Hull, Hull, United Kingdom
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Martin Orrell
- Department of Mental Health Sciences, University College London, London, United Kingdom
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Abstract
Due to the unprecedented increase in the United States aging demographics, many more people are living longer and reaching older ages than ever before. However, a longer life is not necessarily a better life, as the vast majority will face a period of prolonged deteriorating health prior to death. Although notable efforts have been underway that are designed to improve the end-of-life experience, increasing numbers of individuals express a desire and/or act upon an intent to end their lives precipitously. Though still limited, the options to actively participate in their own deaths are growing. Requests for a hastened death can occur among people of all ages and includes those with advanced illness as well as others wanting to die due to unbearable suffering. This article provides an overview of the ongoing discourse about the experience of dying faced by many older adults, including aspects frequently associated with "a good death." The limitations of established practices which seek to provide a "better" dying experience are identified followed by discussion of the growing availability of alternative options. Reflective considerations are presented to guide practice vis-à-vis the changing landscape surrounding options in dying.
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Affiliation(s)
- Kathy Black
- a College of Arts and Sciences , University of South Florida, Sarasota-Manatee , Sarasota , Florida , USA
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McCusker E, Loy CT. The many facets of unawareness in huntington disease. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:257. [PMID: 25411649 PMCID: PMC4231168 DOI: 10.7916/d8fj2fd3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 10/14/2014] [Indexed: 12/01/2022]
Abstract
Background Unawareness or diminished awareness is present when a patient's perception of obvious disease manifestations and impact differ from that of observers such as clinicians or family members. Methods We examined studies that specifically investigate unawareness in Huntington disease (HD). Results Unawareness of motor, cognitive, behavioral, and functional aspects of HD has been documented throughout the disease course. This can occur at motor and cognitive onset but is more pronounced as the disease progresses. Discussion We discuss the implications for diagnosis, symptom report at presentation, timing of diagnosis, acceptance of symptomatic care strategies, and reporting in clinical trials. Assessments of work place competency, discrimination, driving, and the particular challenges of isolated patients without caregivers are described. Engaging with a person who is unaware of their disease or its impact presents a number of conflicts, including maintaining the right to autonomy, privacy, confidentiality, and independence while recognizing concerns for the wellbeing of the vulnerable person with HD and their caregiver when the unaware person refuses assistance. Unawareness is seen increasingly as neurologically based due to the impairment of functional networks, predominantly in nondominant frontostriatal pathways.
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Affiliation(s)
- Elizabeth McCusker
- Huntington Disease Service, Westmead Hospital, Westmead, Australia ; The University of Sydney, Sydney, Australia
| | - Clement T Loy
- Huntington Disease Service, Westmead Hospital, Westmead, Australia ; The University of Sydney, Sydney, Australia
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Abstract
Purpose
– This study aims to systematically evaluate the impact and effectiveness of two early intervention services in NW Kent.
Design/methodology/approach
– Data were gathered via evaluation questionnaires for both projects; these included quantitative post-intervention data and qualitative comments. Data on referrals to secondary care and a specialist third sector organisation were also collected for the primary care project.
Findings
– Findings from the primary care project indicate that targeting a specific age cohort of patients can be effective in terms of: early identification of dementia-related concerns, the provision of support, appropriate referrals to secondary care, and increased referrals to a third sector dementia service. At the end of the project most practitioners felt they were better informed about dementia, more committed to facilitating early diagnosis, and had gained confidence in using a screening tool (the General Practitioner Assessment of Cognition Test). Evidence from evaluating the Carers Group suggests that attendance helped members manage emotional difficulties, increased understanding of dementia, and enhanced coping skills. They also felt less isolated and knew how to access support services.
Practical implications
– The projects offer two models of intervention: how a proactive third sector agency can work with primary care professionals to enhance commitment to dementia case finding and the provision of group support to relatives of those in receipt of a recent dementia diagnosis.
Originality/value
– The study provides insights into early intervention in dementia care how to evaluate impact of effectiveness.
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Samsi K, Abley C, Campbell S, Keady J, Manthorpe J, Robinson L, Watts S, Bond J. Negotiating a labyrinth: experiences of assessment and diagnostic journey in cognitive impairment and dementia. Int J Geriatr Psychiatry 2014; 29:58-67. [PMID: 23625551 DOI: 10.1002/gps.3969] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/12/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES There has been a global push towards the earlier diagnosis of dementia, but there is little understanding of the transitions along the assessment and diagnostic pathway from the perspective of people affected by memory problems, cognitive impairment and early dementia. This study explores the experience of the assessment and diagnostic pathway for people with cognitive impairment and their family carers. METHODS Qualitative interviews with 27 people with cognitive impairment and 26 carers (20 dyads) using four memory services before and after diagnosis disclosure were conducted. Interview transcripts were subject to constant comparative analysis and interpretations subject to discussion at regular 'analysis clinics'. RESULTS Twelve sub-themes were identified along four points on the assessment journey. Feelings of confusion, uncertainty and anxiety over interminable waiting times dominated. Participants often felt without support to manage their uncertainties, emotions and did not know where to turn for support. Some were highly critical of the systemic process of assessment and diagnosis disclosure but were generally positive of the practice of individual professionals. CONCLUSIONS Service providers should review the process of assessment and diagnosis disclosure for people with cognitive impairment and their carers. They should develop a process that is person centred and accommodates the individualised preferences. The development of service systems to provide continuous relevant information and clarity to service users needs to involve all stakeholders, including people with cognitive impairment and their carers.
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Affiliation(s)
- Kritika Samsi
- Social Care Workforce Research Unit, King's College London, London, UK
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20
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Mitchell G, McCollum P, Monaghan C. The personal impact of disclosure of a dementia diagnosis: a thematic review of the literature. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/bjnn.2013.9.5.223] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gary Mitchell
- Dementia Care Unit and PhD Student, Queens University Belfast, Northern Ireland
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Milne A, Guss R, Russ A. Psycho-educational support for relatives of people with a recent diagnosis of mild to moderate dementia: An evaluation of a ‘Course for Carers’. DEMENTIA 2013; 13:768-87. [DOI: 10.1177/1471301213485233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Currently there are 820,000 people with dementia in the UK, a figure projected to reach 1.7 million by 2050. Policy and practice emphasis on early intervention in dementia and support of family carers foreground a need to explore service efficacy for relatives of those with a recent diagnosis. Existing evidence suggests that psycho-educational interventions can significantly enhance carer well being especially when well targeted and group based. A rolling programme of seven psycho-educational Courses for ‘new carers’ in one area of England was the subject of a systematic evaluation incorporating a quantitative rating scale and qualitative data. Findings suggest that the Courses achieved a number of intersecting aims: they provided psychological support; offered advice; enhanced coping skills; boosted confidence; increased knowledge; and prepared the carer for the future. That the Courses were designed and delivered by specialist staff – primarily psychologists, offered a social dimension, were time limited and free are noteworthy features. The evaluation suggests that as a model the Course has considerable short and longer term preventive potential; also that it could be replicated elsewhere in the country and achieve similar outcomes.
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Affiliation(s)
| | - Reinhard Guss
- Psychology Services for Older People, Kent, UK; Kent and Medway NHS Partnership Trust, UK
- University of Kent, UK
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von Kutzleben M, Schmid W, Halek M, Holle B, Bartholomeyczik S. Community-dwelling persons with dementia: what do they need? What do they demand? What do they do? A systematic review on the subjective experiences of persons with dementia. Aging Ment Health 2012; 16:378-90. [PMID: 22250961 DOI: 10.1080/13607863.2011.614594] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Including the perspectives of persons with dementia (PwD) is essential in order to organize care structures for them. With this systematic review, we set out to screen the existing scientific evidence on self-expressions of community-dwelling individuals with dementia in order to provide a research base for developing an intervention for persons in early stages of the disease. The leading research questions for this review are: What needs do PwD living at home express? What are their subjective demands? What do they do to cope with their situation? METHODS We performed a systematic literature review of review publications on subjective experiences of PwD. The publications were analysed using MAXQDA 10 to perform a thematic analysis. RESULTS We identified 41 relevant reviews, of which 6 met our inclusion criteria. PwD experience the whole range of human emotions. Their needs and demands do not differ significantly from those of other groups of patients with chronic conditions. Coming to terms with the disease and maintaining normality appeared to be major themes. With regard to expectations from the side of professional health care, the need for accompanying, continuous support and counselling appeared to be central. Furthermore, disclosure of diagnosis represents a critical stage for PwD, but our findings indicated that they prefer to be included in this process. CONCLUSIONS PwD are well able to express their needs. They should be included in research since they can provide valuable findings. Furthermore, those findings should be implemented in applied dementia care.
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Cognitive Impairment in Older Adults. TOPICS IN GERIATRIC REHABILITATION 2012. [DOI: 10.1097/tgr.0b013e31825932d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Self-neglect is a serious and growing problem among older adults. A 2004 survey from Adult Protective Services (APS) showed that adults age 60 or older were named in 85,000 reports of self-neglect from 21 states (Naik, Lai, Kunik, & Dyer, 2008; Teaster, Dugar, Mendiondo, Abner, & Cecil, 2006). Although rehabilitation nurses are obligated to uphold the autonomy of older adults and strengthen their independence, dilemmas result when people's poor health behaviors put them or others at risk for negative consequences. When making decisions about nursing actions related to self-neglecting elderly people, the basic principles of autonomy, beneficence, nonmaleficence, and capacity must be considered. The purpose of this article is to discuss major ethical perspectives related to self-neglect among older adults.
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Hamilton-West KE, Milne AJ, Chenery A, Tilbrook C. Help-seeking in relation to signs of dementia: a pilot study to evaluate the utility of the common-sense model of illness representations. PSYCHOL HEALTH MED 2011; 15:540-9. [PMID: 20835964 DOI: 10.1080/13548506.2010.487109] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite the importance of early diagnosis of dementia, little is known about the factors underlying help-seeking in relation to signs of the condition. In this pilot study, we aimed to examine the potential utility of the common sense model (CSM) of illness representations for understanding lay perceptions of dementia and predicting intentions to seek help in relation to possible signs and symptoms. A secondary aim was to develop a measure of (dementia-related) illness representations as a tool for future research. After reading a vignette describing a "relative" with mild or moderate dementia, participants (N = 118) completed measures of illness representations and help-seeking intentions. Analyses compared perceptions of the mild and moderate vignettes and determined the extent to which illness perceptions differentiated between alternative forms of help-seeking (e.g. seeking professional help vs. help from family members). Results indicated that cognitive deficits were more readily identified as dementia than non-cognitive symptoms; these were commonly attributed to stress or depression. Participants were more likely to indicate an intention to seek professional help if they identified the problem in the vignette as dementia, perceived symptoms as severe, as having serious consequences and as likely to be permanent, but less likely to do so if they identified the problem as stress or attributed symptoms to psychological causes. Our preliminary data suggests that help-seeking may be prevented by inaccurate illness representations or misattribution of symptoms. The CSM may provide a useful framework for understanding perceptions of dementia symptoms and for informing help-seeking pathways.
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Lawrence V, Samsi K, Banerjee S, Morgan C, Murray J. Threat to valued elements of life: the experience of dementia across three ethnic groups. THE GERONTOLOGIST 2010; 51:39-50. [PMID: 20724657 DOI: 10.1093/geront/gnq073] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE There is a fundamental knowledge gap regarding the experience of dementia within minority ethnic groups in the United Kingdom and elsewhere. The present study examined the subjective reality of living with dementia from the perspective of people with dementia within the 3 largest ethnic groups in the United Kingdom. DESIGN AND METHODS This was a qualitative study in which in-depth individual interviews were conducted with 11 Black Caribbean, 9 south Asian, and 10 White British older people with dementia. The lack of information in this area prompted the use of a grounded theory approach. RESULTS The main theme to emerge from the interviews with the people with dementia was "threat to valued elements of life." Participants engaged in a process of appraisal in which they assessed the degree to which their condition and support needs interfered with valued elements of life. The analysis revealed that each element of this process was culturally informed. IMPLICATIONS There is potential for modifying beliefs to reduce the perceived threat of dementia and for family and professional carers to promote the roles, relationships, and activities that each person with dementia values. The findings outlined in this paper can inform the development of a culturally sensitive approach.
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Affiliation(s)
- Vanessa Lawrence
- Institute of Psychiatry, King's College London, P026, De Crespigny Park, London SE5 8AF, UK.
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29
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Manthorpe J, Iliffe S, Samsi K, Cole L, Goodman C, Drennan V, Warner J. Dementia, dignity and quality of life: nursing practice and its dilemmas. Int J Older People Nurs 2010; 5:235-44. [DOI: 10.1111/j.1748-3743.2010.00231.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Milne A. Dementia screening and early diagnosis: The case for and against. HEALTH RISK & SOCIETY 2010. [DOI: 10.1080/13698570903509497] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The aim of this study was to analyse how patients with mild Alzheimer's disease (AD) cope with the changes they face concerning everyday life and social relations. This study used a grounded theory approach in the analysis of interview data from 11 persons with mild AD, home-living with a spouse. The analysis revealed that the basic social psychological problem faced by patients with mild AD was their awareness of decline in personal dignity and value. Coping strategies used to meet these problems were adaptations to the altered situation in order to maintain a feeling of well-being. The spouse appeared to be the most important social relation. The most significant worries of the patients were about communication in relation to their spouse, and about the reaction of the spouse to the consequences of the disease.
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Clare L, Goater T, Woods B. Illness representations in early-stage dementia: a preliminary investigation. Int J Geriatr Psychiatry 2006; 21:761-7. [PMID: 16906633 DOI: 10.1002/gps.1558] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The self-regulation model of adjustment to illness suggests that individual differences in coping and responding are related to the illness representations people hold. The present study explored the feasibility of applying this concept with people with early-stage dementia. METHOD Understanding of the illness was explored in semi-structured interviews with 22 people who had a diagnosis of mild to moderate Alzheimer's disease or mixed dementia, and a measure of mood was administered. Interview transcripts were subjected to content analysis. RESULTS Representations covering illness identity, cause, course, cure/control and consequences were successfully elicited, but diverged from professional constructs in some important respects. Most participants regarded their difficulties as part of normal ageing, and one-third viewed their condition as stable or improving. Almost all participants described some positive coping strategies; participants who believed that nothing could be done to help were more likely to score above clinical cut-offs for depression or anxiety. CONCLUSIONS The findings offer a preliminary insight into the nature of illness representations in early-stage dementia, and support the relevance of the self-regulation model as a basis for understanding and intervention.
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Affiliation(s)
- Linda Clare
- School of Psychology, University of Wales Bangor, Bangor, UK.
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