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Błaszkiewicz M, Szcześniak D, Ciułkowicz M, Kowalski K, Rymaszewska JE, Bartosz B, Bulińska K, Karczewski M, Brodaty H, Rymaszewska J. Biomedical knowledge of dementia is not enough to counteract its stigma - quantitative research among future medical and social care staff in Poland. Aging Ment Health 2024:1-9. [PMID: 38407168 DOI: 10.1080/13607863.2024.2320139] [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: 09/15/2023] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES The aim is to assess the level of stigmatization and knowledge of dementia among university students of medical, rehabilitation and social faculties in Poland. Possible correlates of these concepts and group differences are also investigated. METHODS We applied quantitative methods using an online questionnaire comprising sociodemographics, the Alzheimer's Disease Knowledge Scale, a vignette of a person with dementia and the modified Family Stigma in Alzheimer's Disease Scale. RESULTS Students had low levels of dementia knowledge and moderate levels of stigma. Medical science students had significantly better knowledge than the other groups but did not differ in their level of stigma. Relationships between the main variables were complex. Emotional and cognitive stigmatizing attributions were negatively correlated with knowledge about communication and behaviors of people with dementia. Better knowledge on causes and characteristics, as well as on risks and health promotion of the disease also triggered fewer negative attributions toward people with dementia. CONCLUSIONS If health-related programs are to be effective, they should provide opportunities for the acquisition of relevant knowledge and skills that also address the stigmatization of people living with dementia. Well-established biomedical knowledge on dementia must be supplemented with a person-centered approach and proper communication skills.
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Affiliation(s)
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland
| | - Marta Ciułkowicz
- Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland
| | | | - Julia E Rymaszewska
- Department and Clinic of Dermatology, Allergology and Venerology, Wrocław Medical University, Wrocław, Poland
| | - Bogna Bartosz
- Institute of Psychology, University of Wroclaw, Wrocław, Poland
| | - Katarzyna Bulińska
- Department of Physiotherapy, Wrocław University of Health and Sport Sciences, Wrocław, Poland
| | - Maciej Karczewski
- Department of Applied Mathematics, University of Environmental and Life Sciences, Wroclaw, Poland
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Joanna Rymaszewska
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, Wrocław, Poland
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Warren A. The relationship between perceived stigma and perceived stress in cognitive decline: a survey of persons with mild cognitive impairment and their caregivers. Front Psychol 2023; 14:1293284. [PMID: 38144994 PMCID: PMC10740212 DOI: 10.3389/fpsyg.2023.1293284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction While Alzheimer's disease and other causes of dementia have rapidly become a global health crisis with growing incidence that is unabated, the incidence of Mild Cognitive Impairment (MCI) far exceeds that of Alzheimer's disease. Persons with MCI demonstrate some level of cognitive impairment, but daily functions remain intact and there is no certainty that they will develop dementia. Yet, the possibility conjures a considerable amount of fear and anxiety, further fueled by a vast array of misconceptions and stigma. The pervasive nature of this stigma permeates society and culture at many levels. Persons with MCI who are at higher risk for development of dementia may be especially vulnerable to fear and stigma associated with the diagnosis. Based on this premise, the primary aim of this study was to examine the relationship between perceived stigma and perceived stress in persons with MCI and their care partners, including the relationship between income and the study variables. The secondary aim was to examine the effect of a combined cognitive rehabilitation and wellness program on these perceptions. Methods Thirty participants were recruited from Mayo Clinic's Health Action to Benefit Independence and Thinking (HABIT) program. MCI (n = 15) and care partner (n = 15) participants completed the Stigma Impact Scale (SIS) and the Perceived Stress Scale (PSS) before and after the HABIT program. Results Average SIS and PSS scores decreased in the MCI, care partner, and combined groups, both pre- and post-HABIT. Linear regression was used to assess the relationship between perceived stigma and stress, controlling for income. A significant relationship was found between perceived stigma and perceived stress both pre and post-HABIT. Discussion The results suggest a relationship exists between perceived stigma and perceived stress in persons with MCI and their care partners, and an educational program such as HABIT may strengthen this relationship by informing participants of potential challenges that occur in cognitive decline. Understanding these relationships may provide an opportunity to provide tools for this vulnerable population.
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Affiliation(s)
- Alison Warren
- The Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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Noguchi T, Nakagawa T, Komatsu A, Shang E, Murata C, Saito T. Role of Interacting and Learning Experiences on Public Stigma Against Dementia: An Observational Cross-Sectional Study. DEMENTIA 2023; 22:1886-1899. [PMID: 37857447 DOI: 10.1177/14713012231207222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: Overcoming dementia stigma is a global challenge. Contact and education on dementia may be promising approaches for reducing public stigma; however, the current evidence is insufficient. This study examined the moderating factors associated with the public stigma against dementia, focusing on experiences of interacting with and learning about people with dementia. Methods: This cross-sectional study recruited 710 adults aged 20-69 years who were not involved in any medical or care work. Participants were recruited via a web-based questionnaire survey for a large internet survey agency's panel in Japan. In terms of the public stigma about dementia, four domains were assessed using a multidimensional assessment scale: personal avoidance, fear of labelling, person-centredness, and fear of discrimination. We compared the stigma scores according to the participants' experiences of interacting with people with dementia ('none', 'talking or activities together', or 'living together') and learning about dementia ('yes' or 'no'), adjusted for demographic and socioeconomic factors.Results: Compared with those without interaction experiences, those with experiences of talking or activities with people with dementia had lower personal avoidance (p = .001), fear of labelling (p = .026), and fear of discrimination (p = .031); those with experiences of living together with people with dementia had lower personal avoidance (p = .014) and fear of discrimination (p = .031). Compared with those without learning experiences related to dementia, those with such experiences had lower personal avoidance (p < .001) and higher person-centredness (p = .048).Conclusions: The findings suggest that the promotion of interaction with and learning about people with dementia may be important for addressing the public stigma.
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Affiliation(s)
- Taiji Noguchi
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
- Japan Society for the Promotion of Science, Japan
| | - Takeshi Nakagawa
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
| | - Ayane Komatsu
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
| | - Erhua Shang
- Department of Human Health, Aichi Toho University, Japan
| | - Chiyoe Murata
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
- Department of Health and Nutrition, Tokai Gakuen University, Japan
| | - Tami Saito
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
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Bhatt J, Kohl G, Scior K, Charlesworth G, Muller M, Dröes RM. Comparing the stigma experiences and comfort with disclosure in Dutch and English populations of people living with dementia. DEMENTIA 2023; 22:1567-1585. [PMID: 37480343 PMCID: PMC10521157 DOI: 10.1177/14713012231188503] [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: 07/24/2023]
Abstract
OBJECTIVES People living with dementia can feel hesitant disclosing their diagnosis to social networks, partly due to stigma. Little attention has been paid to the measurement of disclosure decisions and stigma, and few standardised stigma tools have been validated in languages other than English. We investigated the psychometric properties of Dutch translations of three stigma measures, and explored the stigma experiences of Dutch and English people living with dementia as well as patterns and predictors of comfort with disclosure. METHODS Community-dwelling adults living with dementia in the Netherlands (n = 40) and England (n = 40) completed either the English versions or the Dutch translations of the Comfort with Disclosure scale and three stigma measures (Stigma Impact, Stigma Stress, and Secrecy Scale). We established the psychometric properties of the stigma measures and conducted correlation and regression analyses. RESULTS Internal consistency was good to excellent for all measures in the Dutch sample. Small but significant differences were found between the Dutch and English samples on the total score of the Stigma Impact Scale and its subscale social isolation. Age was negatively associated with comfort disclosing to family, and desire for secrecy was negatively associated with comfort disclosing to both family and friends. CONCLUSIONS The psychometric properties of the Dutch scales were satisfactory. Many people living with dementia would feel comfortable disclosing their diagnosis to family and friends, but stigma experiences can greatly affect this decision. Cross-cultural differences in stigma experiences in persons with dementia require further investigation.
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Affiliation(s)
- Jem Bhatt
- UCL Unit for Stigma Research, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Gianna Kohl
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Katrina Scior
- UCL Unit for Stigma Research, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Research and Development, North East London Foundation Trust, London, UK
| | - Majon Muller
- Department of Internal Medicine, Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc/Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Low LF, Gresham M, Phillipson L. Further development needed: models of post-diagnostic support for people with dementia. Curr Opin Psychiatry 2023; 36:104-111. [PMID: 36705009 DOI: 10.1097/yco.0000000000000848] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW There is increasing recognition of a service gap immediately after diagnosis for people with dementia and carers. This narrative review of models of post-diagnostic support focuses on recent developments and offers suggestions for future development. We present the current evidence for these models and consider the service components they provide against the recommendations of clinical guidelines and principles underpinning ideal post-diagnostic support. RECENT FINDINGS Models of post-diagnostic support include a short-term support worker, ongoing support worker, centre-based support, primary care management, and specialist dementia clinics. Of these, specialist dementia clinics that include ongoing support workers provide most components of an ideal and timely post-diagnostic support framework, but may be more costly to implement universally. The greatest research evidence is for the benefits of long-term support models, specifically case management, though this does not necessarily include medical care or nonpharmacological interventions. There is sparce evidence for the benefits of short-term support worker models such as dementia advisers for people with dementia and carers. SUMMARY Further development is needed to create whole-system models of dementia support which meet the needs of people with dementia and their carers, are timely, accessible and equitable, and can be implemented universally.
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Affiliation(s)
- Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney
| | - Meredith Gresham
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney
| | - Lyn Phillipson
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
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Morton T, Evans SB, Brooker D, Williamson T, Wong G, Tinelli M, Frost F, Bray J, Hullah N. Sustainability of locally driven centres for those affected by dementia: a protocol for the get real with meeting centres realist evaluation. BMJ Open 2022; 12:e062697. [PMID: 35501073 PMCID: PMC9062872 DOI: 10.1136/bmjopen-2022-062697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Improving support for people with early to moderate dementia to live at home in their communities is a global public health goal. Community adult social care is not robust in many parts of the UK, however, with the pandemic increasing pressure on services for this population. Community-led interventions can play a key role in supporting people postdiagnosis, helping delay decline, but many interventions struggle to sustain beyond 1-2 years. Meeting Centres (MCs) are one such intervention, which many UK community groups find attractive and achievable. However, it is not understood how these communities can ensure they are putting in place strategies that will help them sustain in the longer term, beyond start-up phase. METHODS AND ANALYSIS This realist evaluation aims to understand the factors affecting sustainability of MCs in rural areas and learn lessons from MCs that have sustained beyond 3 years. Data will be collected using mixed methods: interviews and group discussions with stakeholders involved at every level in three case study locations in England and Wales, analysed with Soft Systems modelling; a Discrete Choice Experiment exploring what people across the UK value and are willing to pay for MCs, analysed with regression modelling. All data will be synthesised using a Realist logic of analysis to build a theoretical model of how, why, for whom, in what contexts and to what extent MCs can be successfully implemented for the long term. ETHICS AND DISSEMINATION As participants may lack capacity for informed consent, favourable ethical opinion was received from a Health Research Authority research ethics committee. Resulting recommendations will be of interest to stakeholders including those commissioning, planning, running, supporting or attending MCs, as well as policy-makers and healthcare professionals. Knowledge will be shared with emerging MCs to help accelerate scale up of this intervention.
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Affiliation(s)
- Thomas Morton
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Shirley B Evans
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Dawn Brooker
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Tracey Williamson
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Michela Tinelli
- PSSRU, London School of Economics and Political Science, London, UK
| | - Faith Frost
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Jennifer Bray
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Nigel Hullah
- 3 Nations Working Group for Dementia, Swansea, UK
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Lu Y, Liu C, Fawkes S, Ma J, Liu Y, Yu D. Inequality in Social Support Associated With Mild Cognitive Impairment: A Cross-Sectional Study of Older (≥60 Years) Residents in Shanghai, China. Front Public Health 2021; 9:706322. [PMID: 34888276 PMCID: PMC8649958 DOI: 10.3389/fpubh.2021.706322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Social support plays a critical role in the detection and management of mild cognitive impairment (MCI). However, socioeconomic inequalities exist in both social support and health care services. Our study aimed to compare the level of social support received by MCI patients in comparison with those without MCI and to determine its link with income. Methods: Secondary data analyses were performed. Social support was measured using the Duke Social Support Index (DSSI) and satisfaction ratings. Multivariate logistic regression models were constructed to determine the associations of personal income and MCI with social support after adjustment for variations in the sociodemographic and health characteristics of the respondents. The multiplicative and additive interaction effects of income and MCI were further examined through introducing the MCI*Income variable to the regression models and using the relative excess risk due to interaction (RERI) analysis, respectively. Results: The logistic regression models showed that the respondents with MCI had significantly lower social support as measured by the DSSI scores (AOR = 33.03, p < 0.001) and satisfaction ratings (AOR = 7.48, p < 0.001) compared with those without MCI. Similarly, social support decreased with lower personal income (p < 0.001). There existed a significant multiplicative interaction effect between personal income and MCI on social support (AOR = 0.30-0.32, p < 0.01). The gap in social support between those with and without MCI was higher in the higher income group compared with the lower income group (p < 0.001). No significant additive interaction effects on social support were found between MCI and income. Conclusions: There are significant disparities in social support between people living with and without MCI. Such a gap is more profound in people with higher income. The inequality in social support associated with MCI may present a significant challenge to the successful implementation of community MCI detection and management.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Sally Fawkes
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Jia Ma
- Community Health Service Centre of Dinghai in YangPu District, Shanghai, China
| | - Yalin Liu
- Community Health Service Centre of JiaDing Town in JiaDing District, Shanghai, China
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
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Di Tella S, Cabinio M, Isernia S, Blasi V, Rossetto F, Saibene FL, Alberoni M, Silveri MC, Sorbi S, Clerici M, Baglio F. Neuroimaging Biomarkers Predicting the Efficacy of Multimodal Rehabilitative Intervention in the Alzheimer's Dementia Continuum Pathology. Front Aging Neurosci 2021; 13:735508. [PMID: 34880742 PMCID: PMC8645692 DOI: 10.3389/fnagi.2021.735508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022] Open
Abstract
In this work we aimed to identify neural predictors of the efficacy of multimodal rehabilitative interventions in AD-continuum patients in the attempt to identify ideal candidates to improve the treatment outcome. Subjects in the AD continuum who participated in a multimodal rehabilitative treatment were included in the analysis [n = 82, 38 Males, mean age = 76 ± 5.30, mean education years = 9.09 ± 3.81, Mini Mental State Examination (MMSE) mean score = 23.31 ± 3.81]. All subjects underwent an MRI acquisition (1.5T) at baseline (T0) and a neuropsychological evaluation before (T0) and after intervention (T1). All subjects underwent an intensive multimodal cognitive rehabilitation (8–10 weeks). The MMSE and Neuropsychiatric Inventory (NPI) scores were considered as the main cognitive and behavioral outcome measures, and Delta change scores (T1–T0) were categorized in Improved (ΔMMSE > 0; ΔNPI < 0) and Not Improved (ΔMMSE ≤ 0; ΔNPI ≥ 0). Logistic Regression (LR) and Random Forest classification models were performed including neural markers (Medial Temporal Brain; Posterior Brain (PB); Frontal Brain (FB), Subcortical Brain indexes), neuropsychological (MMSE, NPI, verbal fluencies), and demographical variables (sex, age, education) at baseline. More than 50% of patients showed a positive effect of the treatment (ΔMMSE > 0: 51%, ΔNPI < 0: 52%). LR model on ΔMMSE (Improved vs. Not Improved) indicate a predictive role for MMSE score (p = 0.003) and PB index (p = 0.005), especially the right PB (p = 0.002) at baseline. The Random Forest analysis correctly classified 77% of cognitively improved and not improved AD patients. Concerning the NPI, LR model on ΔNPI (Improved vs. Not Improved) showed a predictive role of sex (p = 0.002), NPI (p = 0.005), PB index (p = 0.006), and FB index (p = 0.039) at baseline. The Random Forest reported a classification accuracy of 86%. Our data indicate that cognitive and behavioral status alone are not sufficient to identify best responders to a multidomain rehabilitation treatment. Increased neural reserve, especially in the parietal areas, is also relevant for the compensatory mechanisms activated by rehabilitative treatment. These data are relevant to support clinical decision by identifying target patients with high probability of success after rehabilitative programs on cognitive and behavioral functioning.
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Affiliation(s)
- Sonia Di Tella
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | - Maria Caterina Silveri
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,Università degli Studi di Firenze, NEUROFARBA, Firenze, Italy
| | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,Department of Physiopathology and Transplants, Università degli Studi di Milano, Milan, Italy
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