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Meis C, Corvol A. [Disclosing Alzheimer's disease: Why and how?]. Rev Med Interne 2023; 44:139-142. [PMID: 36781313 DOI: 10.1016/j.revmed.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/13/2022] [Accepted: 01/08/2023] [Indexed: 02/13/2023]
Affiliation(s)
- C Meis
- Université de Rennes, CHU de Rennes, Rennes, France
| | - A Corvol
- Université de Rennes, CHU de Rennes, CNRS, Inserm, CIC 1414, Arènes - UMR 6051, RSMS - U 1309, 35000 Rennes, France.
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Wawrziczny E, Picard S, Buquet A, Traversac E, Puisieux F, Pasquier F, Huvent-Grelle D, Doba K. Hypnosis Intervention for Couples Confronted with Alzheimer’s Disease: Promising Results of a First Exploratory Study. J Alzheimers Dis 2022; 89:1351-1366. [DOI: 10.3233/jad-220430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Dementia has a negative impact on the quality of life of the person with dementia and their spouse caregivers, as well as on the couple’s relationship, which can lead to high levels of distress for both partners. Hypnosis has been shown to be effective in managing distress and increasing the quality of the relationship. Objective: The aim was to develop a standardized hypnosis intervention for couples confronted with Alzheimer’s disease and evaluate its feasibility, acceptability, and helpfulness in managing the distress of both partners and increasing the quality of the relationship. Methods: In a single-arm study, sixteen couples received the 8-week intervention. Qualitative and quantitative assessments were conducted pre- and post-intervention as well as three months after. Results: 88.9% of couples (n = 16) of the final sample (n = 18) completed the intervention. Despite the negative representations of hypnosis, several factors led couples to accept to participate in this study: positive expectations, professional endorsement, medical application, non-drug approach, home-based, free, flexible, and couple-based intervention. The results showed a significant decrease in distress for both partners. These effects were maintained three months after the intervention. Couples felt more relaxed, had fewer negative emotions, accepted difficulties more easily, were more patient, and reported better communication and more affection in the relationship. Conclusion: Overall, this pilot study shows the feasibility and acceptability of hypnosis with couples confronted with Alzheimer’s disease. Although measures of the preliminary pre- and post-intervention effects are encouraging, confirmatory testing with a randomized controlled trial is needed.
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Affiliation(s)
- Emilie Wawrziczny
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
| | - Sandrine Picard
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
| | - Amandine Buquet
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
| | - Elodie Traversac
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
| | - François Puisieux
- Department of Geriatrics, Memory consultation, CHU Lille, Lille, France
| | - Florence Pasquier
- Department of Neurology, Memory Research and Resources Clinic, CHU Lille, Lille, France
| | | | - Karyn Doba
- Laboratory SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq, France
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Nowroozpoor A, Dussetschleger J, Perry W, Sano M, Aloysi A, Belleville M, Brackett A, Hirshon JM, Hung W, Moccia JM, Ohuabunwa U, Shah MN, Hwang U. Detecting Cognitive Impairment and Dementia in the Emergency Department: A Scoping Review. J Am Med Dir Assoc 2022; 23:1314.e31-1314.e88. [PMID: 35940682 PMCID: PMC10804640 DOI: 10.1016/j.jamda.2022.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To identify research and practice gaps to establish future research priorities to advance the detection of cognitive impairment and dementia in the emergency department (ED). DESIGN Literature review and consensus-based rankings by a transdisciplinary, stakeholder task force of experts, persons living with dementia, and care partners. SETTING AND PARTICIPANTS Scoping reviews focused on adult ED patients. METHODS Two systematic scoping reviews of 7 medical research databases focusing on best tools and approaches for detecting cognitive impairment and dementia in the ED in terms of (1) most accurate and (2) most pragmatic to implement. The results were screened, reviewed, and abstracted for relevant information and presented at the stakeholder consensus conference for discussion and ranked prioritization. RESULTS We identified a total of 1464 publications and included 45 to review for accurate tools and approaches for detecting cognitive impairment and dementia. Twenty-seven different assessments and instruments have been studied in the ED setting to evaluate cognitive impairment and dementia, with many focusing on sensitivity and specificity of instruments to screen for cognitive impairment. For pragmatic tools, we identified a total of 2166 publications and included 66 in the review. Most extensively studied tools included the Ottawa 3DY and Six-Item Screener (SIS). The SIS was the shortest to administer (1 minute). Instruments with the highest negative predictive value were the SIS (vs MMSE) and the 4 A's Test (vs expert diagnosis). The GEAR 2.0 Advancing Dementia Care Consensus conference ranked research priorities that included the need for more approaches to recognize more effectively and efficiently persons who may be at risk for cognitive impairment and dementia, while balancing the importance of equitable screening, purpose, and consequences of differentiating various forms of cognitive impairment. CONCLUSIONS AND IMPLICATIONS The scoping review and consensus process identified gaps in clinical care that should be prioritized for research efforts to detect cognitive impairment and dementia in the ED setting. These gaps will be addressed as future GEAR 2.0 research funding priorities.
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Affiliation(s)
- Armin Nowroozpoor
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jeff Dussetschleger
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - William Perry
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Research and Development, James J. Peters VAMC, Bronx, NY, USA
| | - Amy Aloysi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William Hung
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | | | - Ugochi Ohuabunwa
- Division of General Medicine and Geriatrics, Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Manish N Shah
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine (Geriatrics and Gerontology), University of Wisconsin-Madison, Madison, WI, USA; Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.
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Albert SC, Eduardo Martinelli J, Costa Pessoa MS. Dementia and its impacts on the intimate, sexual couple relationship: A systematic review of qualitative research studies. DEMENTIA 2022; 21:1449-1466. [PMID: 35142230 DOI: 10.1177/14713012211073205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE There is growing evidence for the need to recognize persons with dementia as sexual beings who wish to continue expressing their sexuality, including within their couple relationship. The aim of this literature review was to investigate empirical qualitative studies that examined sexuality and sexual intimacy in the couple relationship when one spouse has dementia. METHOD A systematic literature review was performed in January 2021, five data bases were searched: Pubmed, MedLine, Lilacs, Scopus, and SciELO. The references of articles included in the review were screened together with the references of other relevant reviews. RESULTS Nine studies were identified that investigated sexuality and sexual intimacy from the perspective of the couple living with dementia or from the perspective of the spouse. The analysis identified four key themes: addressing dementia and sexuality; challenges to maintaining sexuality within the couple relationship; forms of sexual expression; and the desire to be seen as a sexual being. CONCLUSION Despite evidence of the importance of sexuality in later life and the positive effects it has on the quality of the couple relationship, research has identified the difficulty of destigmatizing sexuality and older persons, particularly when considering couples affected by dementia. Further research is required to better understand how living with the illness impacts sexual expression and the intimacy of the couple relationship.
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Affiliation(s)
- Susan Carol Albert
- Department of Health Sciences, 146840Jundiai Medical University, (Faculdade de Medicina de Jundiaí) Jundiai, Brazil
| | - José Eduardo Martinelli
- Department of Health Sciences, 146840Jundiai Medical University, (Faculdade de Medicina de Jundiaí) Jundiai, Brazil
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Merl H, Veronica Doherty K, Alty J, Salmon K. Truth, hope and the disclosure of a dementia diagnosis: A scoping review of the ethical considerations from the perspective of the person, carer and clinician. DEMENTIA 2022; 21:1050-1068. [PMID: 35134305 DOI: 10.1177/14713012211067882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper explores contemporary approaches to balancing truth with the provision of hope during the disclosure of a dementia diagnosis. We discuss the ethical significance of these practices as they relate to each member of the triad - the person, the carer and the clinician - at the point of diagnosis and beyond. The process of disclosing a diagnosis of dementia is complex. It encompasses breaking bad news while balancing hope, with truth about a progressive life-limiting condition. The process of receiving the diagnosis likewise challenges the person who may be unprepared for the diagnosis, while carers seek information and supports. The impact of receiving a diagnosis of dementia can be life-changing and harmful at the personal level - for both the person and carer. This risk of harm becomes a critical consideration for clinicians when deciding on the level of truth: what information should be relayed and to whom? That risk is also balanced against the ethical issue of patient autonomy, which includes the right to know (or not) and make informed decisions about therapeutic interventions. While the consensus is that the autonomy of the person living with dementia must be upheld, controversy exists regarding the extent to which this should occur. For instance, at diagnosis, it is common for clinicians to use euphemisms rather than the word dementia to maintain hope, even though people and carers prefer to know the diagnosis. This practice of therapeutic lying is a pervasive ethical issue in dementia care, made more acceptable by its roots in diagnosis disclosure.
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Affiliation(s)
- Helga Merl
- Wicking Dementia Research and Education Centre, 60119University of Tasmania, Hobart, TAS, Australia
| | | | - Jane Alty
- Wicking Dementia Research and Education Centre, 60119University of Tasmania, Hobart, TAS, Australia.,Neurology department, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Katharine Salmon
- Wicking Dementia Research and Education Centre, 60119University of Tasmania, Hobart, TAS, Australia
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Tyrrell M, Hedman R, Fossum B, Skovdahl K, Religa D, Hillerås P. Feeling valued versus abandoned: Voices of persons who have completed a cognitive assessment. Int J Older People Nurs 2021; 16:e12403. [PMID: 34231964 DOI: 10.1111/opn.12403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/28/2021] [Accepted: 06/11/2021] [Indexed: 01/10/2023]
Abstract
AIM To describe older persons' experiences of a cognitive assessment and possible neuropsychiatric symptoms [NPS] related to a neurocognitive diagnosis. BACKGROUND A cognitive assessment in primary care is offered to persons with suspected dementia with subsequent referral to a specialist clinic if required. The assessment process, with the likelihood of receiving a dementia diagnosis, is surrounded by uncertainty with long waiting times. Although NPS are common among persons with cognitive impairment persons are not routinely asked about these symptoms during a cognitive assessment. METHOD Interviews were held with 18 participants who had completed a cognitive assessment. The Neuropsychiatric Inventory [NPI] was incorporated into one of the interview questions enabling participants to self-report NPS, if present. Interview data were analysed using Interpretive Description. RESULTS Two main themes were identified: a matter of trust and making sense of a cognitive diagnosis. Experiences of the assessment process ranged from feeling valued to abandoned with variations of trust in the process. A diagnosis of mild cognitive impairment was experienced as an abstract diagnosis devoid of follow-up support. A lack of preparedness for the assessment existed among participants. Some experienced the process as standardised. One half of participants self-reported the presence of one to four NPS, regardless of neurocognitive diagnosis. Irritability and depression were most common NPS identified. CONCLUSIONS Experiences of a cognitive assessment varied from feeling valued by society to abandoned in the absence of follow-up support. The assessment was viewed as a standardised procedure failing to see the person behind the testing. Diagnosis disclosure conversations were experienced as diffuse with participants unprepared for a dementia diagnosis. The NPI enabled participants to identify and report the presence of NPS which otherwise could go undetected during the cognitive assessment, impacting on the person's well-being and daily life.
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Affiliation(s)
- Marie Tyrrell
- Sophiahemmet University, Stockholm, Sweden.,Karolinska Institutet, NVS, Stockholm, Sweden
| | | | - Bjöörn Fossum
- Sophiahemmet University, Stockholm, Sweden.,Karolinska Institutet, SöS, Stockholm, Sweden
| | | | | | - Pernilla Hillerås
- Sophiahemmet University, Stockholm, Sweden.,Karolinska Institutet, NVS, Stockholm, Sweden.,Red Cross University College, Stockholm, Sweden
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Exploring the perceptions and stigmatizing experiences of Israeli family caregivers of people with Parkinson's disease. J Aging Stud 2021; 56:100910. [PMID: 33712095 DOI: 10.1016/j.jaging.2020.100910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022]
Abstract
Providing care to people with Parkinson's disease (PD) poses challenges for family carers, including experiencing stigmatic beliefs -i.e., family stigma. However, to the best of our knowledge, there is no empirical study examining the stigmatic experiences of family members of people with PD. This was the aim of the present study. Three focus groups with 22 Israeli spouses of people with PD were conducted. Data were analyzed using theory-led thematic analysis. Overall, the spouses in our study shared mainly experiences of the stigma attached to the illness and/or to their loved ones, and not to themselves as carers. Three major themes emerged: the stereotypes that typify PD, stigmatizing behaviors towards the person with the disease, and structural stigma. Our findings highlight the profound stigma confronting carers of persons with PD, particularly when it comes to structural stigma.
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Hellström I, Torres S. Couplehood as a compass: Spousal perspectives on the diminished everyday competence of partners. DEMENTIA 2021; 20:2380-2392. [PMID: 33626927 DOI: 10.1177/1471301221997306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research on spousal relations and caregiving, when one of the persons in the dyad has a dementia diagnosis, has recognized that the degree of diminished everyday competence (DEC) the person with dementia is experiencing has implications for these relations and for how spousal caregiving is ultimately experienced. The present exploratory study uses an inductive approach to analyze data from 22 qualitative interviews with and observation notes on couples living with dementia to shed light on the ways in which the person without dementia views the DEC his/her partner is experiencing. The findings show that spouses can choose to disregard their partners' DEC or to acknowledge it in either an egocentric or a couple-centered way; they also show that spouses' choice of approach does not seem to be dictated by how cognitively impaired their partners have become. This suggests that spouses' approach to partners' DEC deserves more of our attention as it could have implications not only for transitions into spousal caregiving but also for caregiving experiences as such.
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Affiliation(s)
- Ingrid Hellström
- Department of Health Care Sciences, 531597Ersta Sköndal Bräcke University College, Stockholm, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Sandra Torres
- Department of Sociology, Uppsala University, Uppsala, Sweden
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Wehrmann H, Michalowsky B, Lepper S, Mohr W, Raedke A, Hoffmann W. Priorities and Preferences of People Living with Dementia or Cognitive Impairment - A Systematic Review. Patient Prefer Adherence 2021; 15:2793-2807. [PMID: 34934309 PMCID: PMC8684431 DOI: 10.2147/ppa.s333923] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Knowledge about the priorities and preferences of people living with dementia (PwD) might help to individualize treatment, care, and support, which could improve patient-related outcomes. This study aimed to summarize preferences of PwD or people with mild cognitive impairment (MCI), considering all relevant aspects of health care and everyday life. METHODS We conducted a systematic literature review and included studies about patient preferences published in English between January 1, 1990 and October 28, 2019. The inclusion criteria were that preferences were elicited directly by PwD or patients with MCI. We used the International Consortium for Health Outcomes Management value set for dementia to categorize the preferences into the following topics: a) clinical status, b) symptoms, functioning, and quality of life, and c) sustainability of care. RESULTS Of 578 initially identified studies, 45 met the inclusion criteria. Patients preferred to be informed about the diagnosis as early as possible, especially for anticipatory care planning. They ranked caregiver quality of life as their highest priority. They preferred not to be a burden to others more than their caregivers' mood, their own functional status, or their own distressing behaviors. Furthermore, PwD are eager to participate in medical decisions, especially in those about creating an everyday life routine. PwD preferred their own quality of life, self-efficacy, and emotional well-being. Institutionalized PwD preferred individualized and person-centered care. According to the sustainability of care, PwD preferred to maintain close bonds with their family at the end of their life and wanted to be treated with empathy. CONCLUSION This systematic review provides essential insights into cognitively impaired patients' preferences, which are rarely considered in treatment, care, and support services. Further studies should evaluate whether considering preferences in treatment and care or daily living can improve patient-reported outcomes.
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Affiliation(s)
- Hannah Wehrmann
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
- Correspondence: Bernhard Michalowsky Tel +49 3834 86 75 07 Email
| | - Simon Lepper
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Wiebke Mohr
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Anika Raedke
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
- Epidemiology of Health Care and Community Health, Institute for Community Medicine & University Medicine Greifswald (UMG), Greifswald, Germany
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Peixoto VGDMNP, Diniz RVZ, Godeiro CDO. SPIKES-D: a proposal to adapt the SPIKES protocol to deliver the diagnosis of dementia. Dement Neuropsychol 2020; 14:333-339. [PMID: 33354284 PMCID: PMC7735056 DOI: 10.1590/1980-57642020dn14-040001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dementia is a life-threatening and stigmatizing condition, with devastating impacts on the patient's personal identity and caregivers. There are many barriers to an effective diagnosis disclosure of dementia, including fear of causing distress, uncertainty of diagnosis, caregivers' objection and lack of training in communication skills in undergraduate medical schools. Although some studies have been published on how to help physicians deliver an Alzheimer's disease diagnosis, no specific protocol has been published yet. The SPIKES protocol is a didactic approach designed to deliver bad news related to cancer, but it has been used globally and in a variety of clinical settings, including the teaching of communication skills to medical students and residents. It is known, however, that the cognitive impairment of Alzheimer's disease and other dementias may limit the understanding of the diagnosis' complexity; hence, a few adaptations of this model were made after reviewing the current literature on dementia diagnosis disclosure. The suggested SPIKES-D protocol seems to encompass current guidelines about the communication of the diagnosis of dementia, keeping its didactic approach on breaking bad news and helping fulfill the gaps in this topic.
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Abstract
The capacity to feel and express themselves in response to worldly surroundings is a defining feature of who a person living with dementia is, and can have profound effects on the ways in which they think, act and express creativity. Drawing on a year of intensive collaborative work with residents living with dementia in an Orthodox Jewish care home in London, I extend our perceptions and understandings of how a couple experiences their day-to-day lives, with particular attention paid to their affective practice in creativity. I demonstrate how the affective creativity of the couple emerges, circulates, and transforms as a spouse's dementia develops, whilst feeling bodies continuously (re)make relations and familiarize themselves with the immediate surroundings through the making of artworks.
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Affiliation(s)
- Jong-Min Jeong
- Department of Social Anthropology, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
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Abstract
UNLABELLED ABSTRACTObjectives:Recent research has demonstrated the challenges to self-identity associated with dementia, and the importance of maintaining involvement in decision-making while adjusting to changes in role and lifestyle. This study aimed to understand the lived experiences of couples living with dementia, with respect to healthcare, lifestyle, and "everyday" decision-making. DESIGN Semi-structured qualitative interviews using Interpretative Phenomenological Analysis as the methodological approach. SETTING Community and residential care settings in Australia. PARTICIPANTS Twenty eight participants who self-identified as being in a close and continuing relationship (N = 13 people with dementia, N = 15 spouse partners). Nine couples were interviewed together. RESULTS Participants described a spectrum of decision-making approaches (independent, joint, supported, and substituted), with these approaches often intertwining in everyday life. Couples' approaches to decision-making were influenced by "decisional," "individual," "relational," and "external" factors. The overarching themes of "knowing and being known," "maintaining and re-defining couplehood" and "relational decision-making," are used to interpret these experiences. The spousal relationship provided an important context for decision-making, with couples expressing a history and ongoing preference for joint decision-making, as an integral part of their experience of couplehood. However, the progressive impairments associated with dementia presented challenges to maintaining joint decision-making and mutuality in the relationship. CONCLUSIONS This study illustrates relational perspectives on decision-making in couples with dementia. Post-diagnostic support, education resources, proactive dyadic interventions, and assistance for spouse care partners may facilitate more productive attempts at joint decision-making by couples living with dementia.
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Bielsten T, Lasrado R, Keady J, Kullberg A, Hellström I. Living Life and Doing Things Together: Collaborative Research With Couples Where One Partner Has a Diagnosis of Dementia. QUALITATIVE HEALTH RESEARCH 2018; 28:1719-1734. [PMID: 30033851 DOI: 10.1177/1049732318786944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The aim of this study is to identify relevant content for a self-management guide by using the outcomes of previous research in combination with knowledge and experiences from couples where one partner has a diagnosis of dementia. The study was carried out in three phases: (a) literature search of previous research related to well-being and couplehood in dementia; (b) interviews with couples with dementia based on the findings of the literature search; and (c) further authentication of the findings within expert groups of people with dementia and carers. For analysis of data, we used a hybrid approach of thematic analysis with combined deductive and inductive approaches. The findings of this study indicated that the four main themes "Home and Neighborhood," "Meaningful Activities and Relationships," "Approach and Empowerment," and "Couplehood" with related subthemes could be appropriate targets for a self-management guide for couples where one partner has a diagnosis of dementia.
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Affiliation(s)
| | - Reena Lasrado
- 2 University of Manchester, Manchester, United Kingdom
| | - John Keady
- 2 University of Manchester, Manchester, United Kingdom
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‘How do they want to know?’ Doctors’ perspectives on making and communicating a diagnosis of dementia. DEMENTIA 2018; 18:3004-3022. [DOI: 10.1177/1471301218763904] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent drives to facilitate earlier identification of dementia have led to increased memory clinic referrals and diagnoses. This study explored the perspectives of memory clinic doctors on making and delivering diagnoses. Four focus groups were conducted with 13 psychiatrists and two geriatricians in the UK. Transcripts were coded line by line using NVIVO. Thematic analysis identified 39 categories, 18 sub-themes and eight overarching themes. Inter-rater reliability on 31% of the data was 0.89. Increased public awareness of dementia was viewed positively in facilitating access to diagnosis and treatment. Doctors viewed diagnosis as a process and expressed concerns about limited pre-diagnostic counselling and post-diagnostic support. In diagnostic delivery doctors sought to develop a narrative drawing on the patient’s report of symptoms and adjust explanations to patient preferences and awareness. However, tailoring the delivery to the individual patient was challenging when meeting for the first time. These consultations often involved three participants (doctor, patient and relative), who were felt to have differing needs and expectations. Doctors emphasized that delicacy was required in deciding in what could be discussed in front of both parties, however also stressed the importance of explicitly naming ‘dementia’. Efforts were made to balance honesty and hope when discussing prognosis and medication. The work was sometimes emotionally distressing, with limited supervision. Existing communication training was felt to be inadequate for consultations involving triads or people with cognitive impairment. Delivering a dementia diagnosis is a nuanced and challenging task. Negotiating honest descriptions of a life-limiting condition whilst instilling hope is further complicated when cognitive impairment affects comprehension. Misunderstandings at the time of feedback may limit patient opportunities for informed future planning afforded by early diagnosis. Doctors in memory clinics would benefit from evidence based training and supervision to prepare them for these emotionally challenging and complex consultations.
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Hoppe S. A Sorrow Shared is a Sorrow Halved: The Search for Empathetic Understanding of Family Members of a Person with Early-Onset Dementia. Cult Med Psychiatry 2018; 42:180-201. [PMID: 28779277 PMCID: PMC5842262 DOI: 10.1007/s11013-017-9549-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this article, I explore how family members of a person with early-onset dementia in the Netherlands attempt to achieve empathetic understanding from significant others, and the barriers they encounter in the process. Based on qualitative interviews, I show that the type of relationship shapes the choices people have to communicate their suffering and their expectations regarding the reactions of others. This article builds on theoretical work on empathy and problematises the notion of shared experiences. It focuses on empathy between family members and significant others, arguing that empathetic understanding between these people is a field of study thus far insufficiently explored.
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Affiliation(s)
- Silke Hoppe
- Centre for Social Science and Global Health, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands.
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O'Connor D, Mann J, Wiersma E. Stigma, discrimination and agency: Diagnostic disclosure as an everyday practice shaping social citizenship. J Aging Stud 2018; 44:45-51. [DOI: 10.1016/j.jaging.2018.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/05/2018] [Accepted: 01/07/2018] [Indexed: 10/18/2022]
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Ashworth R. Perceptions of stigma among people affected by early- and late-onset Alzheimer's disease. J Health Psychol 2017; 25:490-510. [PMID: 28810495 DOI: 10.1177/1359105317720818] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
= 14). Perceived stigma reporting was low in the questionnaires, whereas interviews revealed higher levels of perceived stigma in the form of unpredictable reactions to diagnosis, feeling stupid and ignorance of the condition among the public. Perceived stigma was managed in similar ways across age groups, focusing on 'being the lucky ones'. Results support the need to further tackle stigma and challenge expectations, particularly given the drive to diagnose people and thereby expose them to stigma.
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Zizzo N, Bell E, Lafontaine AL, Racine E. Examining chronic care patient preferences for involvement in health-care decision making: the case of Parkinson's disease patients in a patient-centred clinic. Health Expect 2016; 20:655-664. [PMID: 27624704 PMCID: PMC5513015 DOI: 10.1111/hex.12497] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 11/30/2022] Open
Abstract
Background Patient‐centred care is a recommended model of care for Parkinson's disease (PD). It aims to provide care that is respectful and responsive to patient preferences, values and perspectives. Provision of patient‐centred care should entail considering how patients want to be involved in their care. Objective To understand the participation preferences of patients with PD from a patient‐centred care clinic in health‐care decision‐making processes. Design, setting and participants: Mixed‐methods study with early‐stage Parkinson's disease patients from a patient‐centred care clinic. Study involved a modified Autonomy Preference Index survey (N=65) and qualitative, semi‐structured in‐depth interviews, analysed using thematic qualitative content analysis (N=20, purposefully selected from survey participants). Interviews examined (i) the patient preferences for involvement in health‐care decision making; (ii) patient perspectives on the patient–physician relationship; and (iii) patient preferences for communication of information relevant to decision making. Results Preferences for participation in decision making varied between individuals and also within individuals depending on decision type, relational and contextual factors. Patients had high preferences for communication of information, but with acknowledged limits. The importance of communication in the patient–physician relationship was emphasized. Discussion Patient preferences for involvement in decision making are dynamic and support shared decision making. Relational autonomy corresponds to how patients envision their participation in decision making. Clinicians may need to assess patient preferences on an on‐going basis. Conclusion Our results highlight the complexities of decision‐making processes. Improved understanding of individual preferences could enhance respect for persons and make for patient‐centred care that is truly respectful of individual patients’ wants, needs and values.
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Affiliation(s)
- Natalie Zizzo
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, QC, Canada.,Division of Experimental Medicine and Biomedical Ethics Unit, McGill University, Montreal, QC, Canada
| | - Emily Bell
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Anne-Louise Lafontaine
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,McGill University Health Centre, Montreal, QC, Canada
| | - Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, QC, Canada.,Division of Experimental Medicine and Biomedical Ethics Unit, McGill University, Montreal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
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Hansen A, Hauge S, Bergland Å. Balancing the use of language to enable care: a qualitative study of oral and written language used in assessments and allocations of community healthcare services for persons with dementia. BMC Health Serv Res 2016; 16:391. [PMID: 27530603 PMCID: PMC4988005 DOI: 10.1186/s12913-016-1659-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 08/11/2016] [Indexed: 11/15/2022] Open
Abstract
Background Although a large number of people are diagnosed with dementia each year, the syndrome is still perceived as a sensitive and tabooed topic. Communication about dementia to those living with the syndrome and their relatives is often experienced as challenging by health professionals. Failure to communicate clearly may threaten assessment and allocation of appropriate, effective healthcare services. Accordingly, the aim of this study was to explore how purchasers, assessing and allocating healthcare services to home-dwelling older people with dementia, described challenges in communicating about dementia with those with the syndrome and their relatives. Furthermore, the study aimed to explore the purchasers’ justifications for their choice of words. Methods A qualitative study was conducted to investigate two data sources: focus group interviews with purchasers assessing need for healthcare services, and a review of administrative decisions written by those allocating services. Focus group data were explored using an interpretive approach and qualitative content analysis was carried out with the administrative decisions. Results The purchasers found it challenging to talk and write about dementia to those with the syndrome and their relatives when assessing and allocating services. The purchasers were flexible in their communication and aimed to be open when talking and writing about dementia. However, euphemisms and omission were used extensively. Four justifications for the chosen verbal and written language were identified: avoiding disclosure; protecting the person with dementia; protecting the relatives/avoiding conflict; and last, taboo and stigma. Conclusions Despite purchasers experiencing difficulties in communicating about dementia to those with the syndrome and their relatives, they did manage to communicate in a conscious and flexible way. The purchasers had several justifications for their language choice. However, extensive use of euphemisms and omission might threaten appropriate identification of needs and provision of high quality healthcare services. The challenges experienced by the purchasers demonstrate the need to focus on appropriate and flexible strategies for individually-tailored communication about dementia with people living with the syndrome. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1659-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anette Hansen
- Faculty of Health and Social Sciences and Centre for Care Research, University College of Southeast Norway, Postbox 235, , 3603, Kongsberg, Norway.
| | - Solveig Hauge
- Faculty of Health and Social Sciences and Centre for Care Research, University College of Southeast Norway, Postbox 235, , 3603, Kongsberg, Norway
| | - Ådel Bergland
- Institute of Health and Society, Department of Nursing Science and Lovisenberg Diaconal University College, University of Oslo, Lovisenberggaten 15b, 0456, Oslo, Norway
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Abstract
OBJECTIVES Whether and how patients should be told their dementia diagnosis, has been an area of much debate. While there is now recognition that early diagnosis is important for dementia care little research has looked at how dementia-related diagnostic information is actually verbally communicated. The limited previous research suggests that the absence of explicit terminology (e.g., use of the term Alzheimer's) is problematic. This paper interrogates this assumption through a conversation analysis of British naturalistic memory clinic interaction. METHOD This paper is based on video-recordings of communication within a UK memory clinic. Appointments with 29 patients and accompanying persons were recorded, and the corpus was repeatedly listened to, in conjunction with the transcripts in order to identify the segments of talk where there was an action hearable as diagnostic delivery, that is where the clinician is evaluating the patient's condition. RESULTS Using a conversation analytic approach this analysis suggests that diagnostic communication, which is sensitive and responsive to the patient and their carers, is not predicated on the presence or absence of particular lexical choices. There is inherent complexity regarding dementia diagnosis, especially in the 'early stages', which is produced through and reflected in diagnostic talk in clinical encounters. CONCLUSION In the context of continuity of dementia care, diagnostic information is communicated in a way that conforms to intersubjective norms of minimizing catastrophic reactions in medical communication, and is sensitive to problems associated with 'insight' in terms of delivery and receipt or non-receipt of diagnosis.
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Affiliation(s)
- Elizabeth Peel
- Institute of Health & Society, Psychology Department, University of Worcester, Worcester, UK,
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Hellström I, Torres S. The "not yet" horizon: Understandings of the future amongst couples living with dementia. DEMENTIA 2014; 15:1562-1585. [PMID: 25547209 DOI: 10.1177/1471301214565673] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The way in which persons with dementia and their spouses regard the future could influence how they experience the disease itself. This study aims to explore how the future is understood by couples living with dementia. The analysis reveals different ways in which couples understand the future. The findings show that persons with dementia describe the here and now in ways that take the gloomy future they dread as a point of reference, and as a result of this, they operate in what we term "the not yet horizon". But while they take for granted that there is a horizon that they have not yet reached, their spouses always seem to focus on the horizons that they have already crossed. The article discusses the findings in relation to ideas such as critical periods, existential coordinates and possible selves, and problematizes the implicit assumptions about the future that dementia researchers tend to operate from.
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Affiliation(s)
- Ingrid Hellström
- Department of Social and Welfare Studies & Center for Dementia Research, Linköping University, Norrköping, Sweden
| | - Sandra Torres
- Department of Sociology, Uppsala University, Uppsala, Sweden
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Abstract
BACKGROUND The literature available on the format of the feedback session following assessment of memory impairment is minimal. This study explored how this information should be presented from the perspective of patients and their families. METHODS Thirty-two semi-structured interviews were conducted with memory clinic patients and their carer at the clinic visit that followed the feedback session, to ask: what they recalled, what they found helpful, and what they thought was the best way to disclose a diagnosis of dementia. A second interview was conducted with 14 patient/carer dyads at their next appointment. RESULTS Recall of information from the feedback session was variable. Most respondents (76% of patients; 66% of carers) thought that a direct approach was best when informing the patient of a dementia diagnosis, and that both written information and compassion demonstrated by the doctor were helpful. Opinions on whether all the information should be given at once or in stages were divided. CONCLUSIONS The current format of the feedback session needs revision to improve recall. Patients and their families want a direct approach to be used by a supportive and professional doctor with an opportunity to ask questions. They want the support of a family member or friend when they are told of their diagnosis and they would like a written summary to refer to afterwards.
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Murphy K, Jordan F, Hunter A, Cooney A, Casey D. Articulating the strategies for maximising the inclusion of people with dementia in qualitative research studies. DEMENTIA 2014; 14:800-24. [DOI: 10.1177/1471301213512489] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It is essential to understand the experience of living with dementia from the perspective of the person with dementia so that services can be appropriately constructed. This review paper, drawing on prior work, identifies key strategies for the meaningful inclusion of persons with dementia within qualitative research studies, it examines the articulation of these strategies and shares how these strategies were operationalised within one national research study in Ireland. Strategies within the literature were categorised and then synthesized into a guide consisting of four main areas; gaining COnsent, maximizing Responses, Telling the story, and Ending on a high (CORTE). The CORTE guideline was used to as a tool for analysing relevant research reports. CORTE is a synthesized account of grouped strategies that could be used to maximize the meaningful involvement of persons with dementia and can also provide a guide for reporting the strategies used so that researchers can learn from each other.
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Affiliation(s)
- Kathy Murphy
- School of Nursing and Midwifery, Aras Moyola, NUI, Galway, Ireland
| | | | - Andrew Hunter
- School of Nursing and Midwifery, NUI, Galway, Ireland
| | | | - Dympna Casey
- School of Nursing and Midwifery, NUI, Galway, Ireland
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