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Korin O, Babis D. Medical clowning in hospitals: practices, training and perception. MEDICAL HUMANITIES 2024; 50:383-391. [PMID: 38360796 DOI: 10.1136/medhum-2023-012785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/17/2024]
Abstract
Previous studies on medical clowning focused on patients, while research remains inadequate concerning clowning itself: training programmes and prerequisite requirements, clowning methods, deontology and accepted practices. Diverse approaches and paradigms in this field of complementary medicine are promoted by non-profit organisations worldwide. Based on an ethnographic study, we explore the current forms of medical clowning in 5 Israeli hospitals. The observed clowns are from the two Israeli organisations, Dream Doctors and Simchat Halev (in Hebrew: joy of the heart), consisting of paid professional medical clowns and volunteers, respectively. According to the findings, significant differences were observed to exist between the organisations. Dream Doctors is conceived and pursued as an expertise practised by performance art professionals, requiring extensive training. These clowns work unaccompanied, receive a salary, are considered members of the medical team, and, given their privileged status, have access to hospitals' open and closed areas. The Dream Doctors consider medical clowning as a paramedical practice, in which interventions are individually suited to the circumstances of each patient, and obtain therapeutic results. In contrast, Simchat Halev's medical clowns are volunteers with no prerequisite artistic background and undergo shorter periods of training. The access granted to these clowns, usually working in pairs, is restricted to open areas. Simchat Halev promotes medical clowning as a volunteer-based public practice, offering general entertainment to all patients indiscriminately, and their contribution is characterised as achieving basic entertainment value.
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Papadimitriou C, Clayman ML, Mallinson T, Weaver JA, Guernon A, Meehan AJ, Kot T, Ford P, Ideishi R, Prather C, van der Wees P. A New Process Model for Relationship-Centred Shared Decision-Making in Physical Medicine and Rehabilitation Settings. Health Expect 2024; 27:e14162. [PMID: 39140244 PMCID: PMC11322820 DOI: 10.1111/hex.14162] [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] [Received: 11/16/2023] [Revised: 06/07/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION We present a relationship-centred shared-decision-making (RCSDM) process model to explicate factors that shape decision-making processes during physical medicine and rehabilitation (PMR) encounters among patients, their care partners and practitioners. Existing shared decision-making (SDM) models fall short in addressing the everyday decisions routinely made regarding persons with chronic disabilities who require high levels of support, their care partners and rehabilitation practitioners. In PMR, these everyday decisions are small scale, immediate and in service to a larger therapeutic goal. They can be thought of as micro-decisions and involve multiple practitioners, care partners and patients. How micro-decisions are made in this context is contingent on multiple roles and relationships among these relevant parties. Our model centres on micro-decisions among patients, their care partners and practitioners based on our disorders of consciousness (DoC) research. METHODS To develop our model, we examined peer-reviewed literature in SDM in PMR, chronic disability and person-centeredness; formed collaborations and co-created our constructs with rehabilitation practitioners and with care partners who have lived experience of caring for persons with DoC; analysed emerging empirical data and vetted early versions with expert scientific and clinical audiences. Our model builds from the core tenets of relational autonomy, and scholarship and activism of disability advocates. FINDINGS Our model conceptualizes four non-hierarchical levels of analysis to understand the process of micro-decision-making in chronic disability and medical rehabilitation: social forces (historical and sociological); roles and relationships (multiple and intersecting); relational dimensions (interactional and contextual) and micro-decision moments (initiation, response and closure). DISCUSSION Relationships among patients, their care partners and practitioners are the intersubjective milieu within which decisions are made. Our conceptual model explicates the process of micro-decision-making in PMR. PATIENT OR PUBLIC CONTRIBUTION Care partners (or caregivers) and rehabilitation practitioners are active members of our team. We work together to develop research projects, collect, analyse and disseminate data. The conceptual model we present in this manuscript was co-created-input from care partners and practitioners on previously collected data became the impetus to develop the RCSDM process model and share co-authorship in this manuscript.
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Affiliation(s)
| | - Marla L. Clayman
- Department of Population and Quantitative Health SciencesEdith Nourse Rogers Memorial Veterans Hospital, UMass Chan Medical SchoolBedfordMassachusettsUSA
| | - Trudy Mallinson
- Department of Clinical Research and LeadershipGeorge Washington UniversityWashingtonDCUSA
| | - Jennifer A. Weaver
- Department of Occupational TherapyColorado State UniversityFort CollinsColoradoUSA
| | - Ann Guernon
- Department of Speech‐Language PathologyLewis UniversityRomeovilleIllinoisUSA
| | - Albert J. Meehan
- Department of Sociology, Anthropology, Criminal Justice, and Social Work, College of Arts & SciencesOakland UniversityRochesterMichiganUSA
| | | | | | - Roger Ideishi
- Department of Occupational TherapyGeorge Washington UniversityWashingtonDCUSA
| | - Christina Prather
- Division of Geriatrics and Palliative MedicineGeorge Washington UniversityWashingtonDCUSA
| | - Philip van der Wees
- Department of Clinical Research and LeadershipGeorge Washington UniversityWashingtonDCUSA
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Martin D, Ivanova D, Simonsen TPH. Moving Beyond Clinical Imaginaries: Technogeographies of the Everyday Urban. THE JOURNAL OF MEDICAL HUMANITIES 2024:10.1007/s10912-024-09872-y. [PMID: 39002097 DOI: 10.1007/s10912-024-09872-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/15/2024]
Abstract
In this paper, we analyse the intersections between care and place in mundane spaces not explicitly designed for the provision of care, and where digital technologies are used to mediate ecologies of distress in the city. We locate our analysis alongside studies of how digital technologies impact the experience of care within non-clinical spaces, whilst noting that much research on the use of technologies for care remains haunted by clinical imaginaries. Bringing together ideas of multi-sited therapeutic assemblages, technogeographies of care, and how places-by-proxy can act as conduits for care, we explore an example of an online app being used in public space to manage experiences of anxiety in an everyday urban environment. We reflect on this illustrative example to trace the movement of care as it is mediated through digital technologies-out of the clinic, beyond the home, and into the ordinary spaces of the city. We conclude that the entanglements of digital technologies and ordinary urban places prompt us to entirely reconsider questions of the where of care.
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Affiliation(s)
| | - Dara Ivanova
- Department of Architecture, TU Delft, Delft, The Netherlands
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Snowball E, Aiken C, Norman M, Hykaway W, Dempster Z, Itzhak I, McLellan E, McGilton KS, Bethell J. Engaging people with lived experience of dementia in research meetings and events: insights from multiple perspectives. FRONTIERS IN DEMENTIA 2024; 3:1421737. [PMID: 39081602 PMCID: PMC11285645 DOI: 10.3389/frdem.2024.1421737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/21/2024] [Indexed: 08/02/2024]
Abstract
This perspective article describes the experiences of engaging people with lived experience of dementia in research meetings and events from the perspectives of people with lived experience, researchers, trainees, audience members and others. We outline examples of engagement from different events and describe a video project, initiated by people with lived experience, conveying diverse views about becoming integral collaborators in the Canadian Consortium on Neurodegeneration in Aging (CCNA) annual Partners Forum and Science Days. We also report evaluation data from audiences and present a series of tips and strategies for facilitating this engagement, including practical considerations for supporting people with lived experience.
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Affiliation(s)
- Ellen Snowball
- Knowledge, Innovation, Talent, Everywhere (KITE) Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Christine Aiken
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Myrna Norman
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Wayne Hykaway
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Zoe Dempster
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Inbal Itzhak
- Knowledge Translation and Exchange Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Emily McLellan
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Katherine S. McGilton
- Knowledge, Innovation, Talent, Everywhere (KITE) Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jennifer Bethell
- Knowledge, Innovation, Talent, Everywhere (KITE) Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Brijnath B, Rao R, Baruah U, Antoniades J, Loganathan S, Varghese M, Cooper C, Kent M, Dow B. Relational Solidarity and Conflicting Ethics in Dementia Care in Urban India. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae079. [PMID: 38708694 PMCID: PMC11157626 DOI: 10.1093/geronb/gbae079] [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] [Received: 09/19/2023] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVES Using the concept of relational solidarity, we examine how autonomy, equality, dignity, and personhood are practiced in the care of people living with dementia at home in urban India. METHODS Video interviews with 19 family carers and 25 health providers conducted in English, Hindi, and Kannada in Bengaluru between March and July 2022. Data were translated into English and thematically analyzed. RESULTS Family carers and providers unanimously agreed that people with dementia should be respected and cared for. Concurrently, they perceived people with dementia as being "like a kid" and used the analogy of a parent-child relationship to understand their care responsibilities. This analogy informed how ethical principles such as personhood and equality were reframed in the relationships between family carers and people with dementia, as well as how carers and providers maintained the safety but undermined the autonomy of people with dementia through restricting their movements inside and outside the home. DISCUSSION There can be relational solidarity in dementia care at home in urban India but also contradictions in the interpretations and applications of the ethical principles of autonomy, equality, dignity, and personhood. As such, a more organic, grassroots model of ethical practice is needed to frame care and provide material support to families in India.
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Affiliation(s)
- Bianca Brijnath
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachita Rao
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Upasana Baruah
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Josefine Antoniades
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Santosh Loganathan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, St John’s Medical College, Bengaluru, Karnataka, India
| | - Claudia Cooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Mike Kent
- School of Media, Creative Arts and Social Inquiry, Curtin University, Perth, Western Australia, Australia
| | - Briony Dow
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Director Division, National Ageing Research Institute, Melbourne, Victoria, Australia
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Long S, Irving K, Murphy C. Is therapeutic lying contradictory to person-centred care? Toward understanding the connection. Aging Ment Health 2024; 28:520-530. [PMID: 37139937 DOI: 10.1080/13607863.2023.2202632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/04/2023] [Indexed: 05/05/2023]
Abstract
AIM There is a lack of clarity about therapeutic lying in the context of everyday dementia care. This study provides conceptual clarity on how the term is used and considers the concept in relation to person-centred care. METHODS Rodgers' (1989) evolutionary framework of concept analysis was employed. A systematic multiple database search was conducted and supplemented with snowballing techniques. Data were analysed thematically through an iterative process of constant comparison. RESULTS This study highlighted that therapeutic lying is intended to be used in the person's best interests for the purpose of doing good. However, its potential for doing harm is also evident. Its use in the literature has increased with the general trend towards becoming more accepted in the discourse. A continuum emerged depending on the degree to which a lie departs from the truth. Emerging guidelines were also evident as to when a lie could or could not be justified. CONCLUSION The term therapeutic lying, was contrasted with aspects of person-centred care and was found to be problematic. We conclude that there may be more pragmatic ways of constructing language around the care of people with dementia which could be less stigmatising.
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Affiliation(s)
- Shirley Long
- Nursing, Community Health Organisation, Dublin, Ireland
| | - Kate Irving
- School of Nursing, Dublin City University, Dublin, Ireland
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Francis L, Ghafurian M. Preserving the self with artificial intelligence using VIPCare-a virtual interaction program for dementia caregivers. FRONTIERS IN SOCIOLOGY 2024; 9:1331315. [PMID: 38375150 PMCID: PMC10875992 DOI: 10.3389/fsoc.2024.1331315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024]
Abstract
Introduction Assistive technology is increasingly used to support the physical needs of differently abled persons but has yet to make inroads on support for cognitive or psychological issues. This gap is an opportunity to address another-the lack of contribution from theoretical social science that can provide insights into problems that cannot be seen. Using Affect Control Theory (ACT), the current project seeks to close that gap with an artificially intelligent application to improve interaction and affect for people with Alzheimer's Disease and Related Dementias (ADRD). Using sociological theory, it models interactions with persons with ADRD based on self-sentiments, rather than cognitive memory, and informs a cellphone-based assistive tool called VIPCare for supporting caregivers. Methods Staff focus groups and interviews with family members of persons with ADRD in a long-term residential care facility collected residents' daily needs and personal histories. Using ACT's evaluation, potency, and activity dimensions, researchers used these data to formulate a self-sentiment profile for each resident and programmed that profile into the VIPCare application. VIPCare used that profile to simulate affectively intelligent social interactions with each unique resident that reduce deflection from established sentiments and, thus, negative emotions. Results We report on the data collection to design the application, develop self-sentiment profiles for the resident, and generate assistive technology that applies a sociological theory of affect to real world management of interaction, emotion, and mental health. Discussion By reducing trial and error in learning to engage people with dementia, this tool has potential to smooth interaction and improve wellbeing for a population vulnerable to distress.
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Affiliation(s)
- Linda Francis
- Department of Criminology and Sociology, Cleveland State University, Cleveland, OH, United States
| | - Moojan Ghafurian
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
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Damsgaard JB, Lauritzen J, Delmar C, Kvande ME. Beyond loss: An essay about presence and sparkling moments based on observations from life coexisting with a person living with dementia. Nurs Philos 2024; 25:e12425. [PMID: 36846929 DOI: 10.1111/nup.12425] [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] [Received: 01/26/2022] [Revised: 12/22/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023]
Abstract
This is an essay based on a story with observations, about present and sparkling moments from everyday life coexisting with a mother living with dementia. The story is used to begin philosophical underpinnings reflecting on 'how it could be otherwise'. Dementia deploys brutal existential experiences such as cognitive deterioration, decline in mental functioning and often hurtful social judgements. The person living with dementia goes through transformation and changes of self. Cognitive decline progressively disrupts the foundations upon which social connectedness is built, often creating a profound sense of insecurity. The challenge for carers and healthcare professionals is therefore to find ways of clarifying a concept of agency. It will be worthwhile developing the ability of attuning into 'what is there' arising from every corner of the care situation. Understanding and practicing this can strengthen existence and the experience of connectedness and meaning, empowering the person with dementia. It is important to find ways, relational moves, in which carers and healthcare professionals can embed the creativity appearing in mundane everyday situations filled with surplus of meaning, sharing mental landscapes (and embodied relational understanding) with the person living with dementia - seizing and sharing aesthetic moments (verbal and nonverbal) being present together. We argue that carers and healthcare professionals may find this understanding of care useful. This implies looking into a phenomenological-hermeneutic perspective developing competences as well as practical wisdom understanding and being aware of the creative and innovative possibilities (often preverbal and unnoticed small things) in everyday life of what we, inspired by psychoanalyst Daniel Stern, call sparkling moments of meeting, creating experience with the other that is personally undergone and lived through in the present.
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Affiliation(s)
- Janne B Damsgaard
- Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark
| | - Jette Lauritzen
- Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark
- VIA University College, Aarhus, Denmark
| | - Charlotte Delmar
- Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark
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Henderson J, Reid C. Virtual collaborative creative engagement in a pandemic world: creative connection for older adults with lived experience of dementia. FRONTIERS IN HEALTH SERVICES 2023; 3:1223337. [PMID: 38162191 PMCID: PMC10754963 DOI: 10.3389/frhs.2023.1223337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Introduction Older adults were disproportionately affected by COVID-19, and isolation and loneliness became key risk factors for mental illness and decreased quality of life. Older adults with lived experience of dementia and their care partners experienced isolation, loneliness, anxiety and depression, already heightened due to social stigma. Reduced access to resources was a notable problem. Objective This Canadian qualitative study investigates the Raising the Curtain on the Lived Experience of Dementia (RTC) Project's virtual turn in program delivery during the pandemic, asking "How did virtual collaborative creative engagement (CCE) impact well-being for people living with dementia and their care partners?"; and "What are key elements of RTC's unique virtual CCE approach?" Methods The study employs reflexive thematic analysis to analyse interviews and focus groups with the project's artist facilitators, researchers, peer collaborators living with dementia, and their care partners. Findings: Themes describe key elements of RTC's unique approach to virtual CCE and include: "Adjusting Expectations and Adapting to Technology"; "Re-imagining Creative Engagement in Virtual Space"; "Sustaining Reciprocal Caring, Learning, and Support"; "Disrupting Stigma and Welcoming a Wider Audience"; and "Supporting Well-being through Empowerment, Community, and Creativity." Discussion Findings offer new perspectives on how virtual CCE not only has the potential to decrease loneliness and isolation and associated mental health risks for older adults living with dementia and their care partners, but also can work to disrupt stigmatizing representations of dementia, promote inclusion, and enhance citizenship.
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Affiliation(s)
- Julia Henderson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Colleen Reid
- Department of Therapeutic Recreation, Douglas College, Coquitlam, BC, Canada
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Papadimitriou C, Lindemann L, Meehan AJ. Making the visible seen: The interactional competence of a person in a disordered state of consciousness. Soc Sci Med 2023; 336:116261. [PMID: 37806147 DOI: 10.1016/j.socscimed.2023.116261] [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] [Received: 05/04/2023] [Revised: 08/18/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
We examine a 12-min video-recorded interaction among a patient (KN) in a disordered state of consciousness (DOC) and a speech language pathologist clinician (CL) that takes place in a medical rehabilitation setting. The video is a demonstration of how caregivers could use a clinical assessment to observe their loved one's behavior to communicate potential behavioral changes to healthcare professionals. The purpose of this paper is to make visible the communication practices used by participants that may not be obvious to researchers, medical rehabilitation practitioners, and clinical assessment developers. We use phenomenological, linguistic and conversation analytic approaches to analyze the interaction. We found that KN demonstrates multiple conversational competencies, some (but not all) of which are acknowledged by CL, and most of which are not directly addressed by the assessment scoring criteria. For example, KN demonstrates conversational competency by responding non-verbally to CL's prompts from the assessment protocol and following along with the unspoken rules of discourse. He does this primarily through gaze, which broadcasts the focus of his attention and actively signals his participation in the conversation. Though KN does not always respond correctly to CL's questions, he nevertheless demonstrates implicit conversational competencies during turns of talk such as returning to 'neutral' position which signals the completion of a turn of talk. KN's conversational competencies may be missed by CL and the assessment protocol but we argue that they are important in understanding KN's capacity. Our analyses show that competency is not simply a performance by one person who appropriately and correctly responds to a series of questions in a prescribed time frame. Competence is a collaborative achievement among participants, co-produced in situ, and influenced by linguistic and cultural habits of talk and epistemic norms that privilege clinical knowledge and expertise.
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Affiliation(s)
| | - Luke Lindemann
- George Washington University, 2121 I St NW, Washington, DC, 20052, USA.
| | - Albert J Meehan
- Oakland University, 318 Meadow Brook Rd, Rochester, MI, 48309, USA.
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11
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Sullivan MP, Camic PM, Harding E, Stott J, Windle G, Brotherhood EV, Grillo A, Crutch SJ. Situating support for people living with rarer forms of dementia. BMC Geriatr 2023; 23:627. [PMID: 37803252 PMCID: PMC10557369 DOI: 10.1186/s12877-023-04268-4] [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] [Received: 06/19/2023] [Accepted: 08/31/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Awareness of a multitude of diseases that can cause neurodegenerative decline and their unique symptom profiles in the dementia care and support sectors remains limited. Obtaining an accurate diagnosis and post-diagnostic care and support is a challenge for many people and their families. As part of a larger study examining multi-component forms of support for people living with rarer dementias, the aim of this present study was to examine how rare dementia was situated within the complex social groupings, their organization and embedded discursive constructions that broadly form dementia care and support delivery. METHODS Adopting a situational analysis approach, we undertook an examination of public documents and organizational websites within the support sector for people living with dementia in Canada, England, and Wales. We also surveyed professionals to further explore the situation at the point of care and support delivery. Consistent with our approach, data collection and analysis occurred concurrently including the development of a series of analytic maps. RESULTS Recognizing the complexities within the situation, our findings provided new insights on the situated structures for support action and the discursive representations that illuminate both the limitations of the current support landscape and possibilities for a more flexible and tailored rare dementia support. Alongside, the predominant universal versus tailored support positionings within our data reinforced the complexity from which a promising new social space for people living with rarer dementias is being cultivated. CONCLUSIONS The social worlds engaged in supportive action with people living with rare dementia are less visible within the shadow of a universally constructed dementia support milieu and appear to be negotiated within this powerful arena. However, their evolving organization and discursive constructions point to an emerging new social space for people living with rarer conditions.
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Affiliation(s)
- Mary Pat Sullivan
- Faculty of Education and Professional Studies, School of Social Work, Nipissing University, North Bay, ON, Canada.
| | - Paul M Camic
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Emma Harding
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Joshua Stott
- Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Gill Windle
- Ageing and Dementia @ Bangor, Dementia Services Development Centre (DSDC), School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Adetola Grillo
- Faculty of Education and Professional Studies, School of Social Work, Nipissing University, North Bay, ON, Canada
| | - Sebastian J Crutch
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
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Tauzer J, Cowdell F, Nässén K. From ethical approval to an ethics of care: Considerations for the inclusion of older adults in ethnographic research from the perspective of a 'humanisation of care framework'. J Aging Stud 2023; 66:101162. [PMID: 37704280 DOI: 10.1016/j.jaging.2023.101162] [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] [Received: 05/24/2022] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 09/15/2023]
Abstract
A deeper understanding of care demands the methodological finesse of qualitative research: we must observe, listen, and witness to expose what matters to care recipients. In this paper, we - a team of three: one early-career researcher and two supervisors - reflect on our experiences of designing and then seeking ethics approval for ethnographic research on care for older adults, many of whom demonstrate a lack of capacity to consent to research. Viewing experiences of well-being and dignity as embedded within interpersonal negotiations, this study privileges care home residents' daily life, looking to stories and observations of daily life to reveal the complexities of well-being in the care home setting. This paper emphasizes the importance of using qualitative research methods to gain a deeper understanding of care practices, particularly in the context of care for older adults with varying cognitive capacities. By privileging the daily life experiences of care home residents and employing the logic of process consent, we aim to include the voices of all participants, not just those who can provide written informed consent. However, obtaining ethics approval for this type of research presents several challenges, requiring careful negotiation and the inclusion of consultee advice. This paper highlights the tensions between procedural ethics and the need for better inclusion of vulnerable populations in ethnographic research on care. By addressing these challenges, we can move towards a more context-sensitive and humanised approach to research ethics that values the lived experiences of care recipients.
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Weicht B, Tolhurst E. The Spousal Unit and Dementia: Investigating the Relational Basis of the Couplehood Concept. Healthcare (Basel) 2023; 11:2191. [PMID: 37570431 PMCID: PMC10418721 DOI: 10.3390/healthcare11152191] [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: 07/06/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
A strong emphasis is consistently placed upon the relational basis of experience within social scientific dementia research. Within this research corpus, the concept of couplehood is increasingly employed, albeit in rather undefined and loosely theorised ways. Moreover, the evaluation highlights that couplehood is often defined by a normative position that seeks to convey an affirmative perspective on dementia and spousal relationships. The lack of theoretical foundation, however, weakens the explanatory potential of the concept, both for theorising dementia, as well as for empirical research. This article critically evaluates the utility of the couplehood concept by delineating three underlying theoretical conceptions: phenomenological, interactional and relational perspectives. It will be argued that those theoretical threads offer different analytical angles and research opportunities. More thorough ontological development, however, can guide understandings of the complexities that underpin the relational experience of dementia. This will promote a conceptual starting point that offers a more balanced and multifaceted accommodation of two persons and their relationship.
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Affiliation(s)
- Bernhard Weicht
- Department of Sociology, University of Innsbruck, 6020 Innsbruck, Austria
| | - Edward Tolhurst
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DE, UK;
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Russell C. "We Can Do This!": The Role of Physical Activity in What Comes Next for Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6503. [PMID: 37569043 PMCID: PMC10418976 DOI: 10.3390/ijerph20156503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/06/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023]
Abstract
There is increasing interest in physical activity as a response to the harm caused by dementia. The focus has been upon interventions to prevent or delay symptoms or to support people living with the condition to reminisce. Whilst this is welcome, there are other features inherent to physical activity that remain unrecognised or underutilised and, consequently, its full potential for good is unrealised. Most prominent is the ability physical activity has to enable participants to claim and sustain a place in the world through what they do, crucial to a context where the impact of dementia tends to annihilate this for those living with the condition. The article addresses this gap. In doing so, it presents key findings. These include (1) highlighting the fundamental importance of features such as person-centred care, human rights and social citizenship to enabling people with dementia to live lives of quality and (2) identifying synergies with these features and what physical activity can offer; for example, emphasising the value of bringing these together to illustrate how physical activity can contribute to enabling people with dementia to live lives characterised by quality, and the maintenance of their place in the world. The article concludes by suggesting what must come next to ensure physical activity can play the fullest role possible.
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Affiliation(s)
- Christopher Russell
- Association for Dementia Studies, University of Worcester, Henwick Grove, Worcester WR2 6AJ, UK
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15
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Zhang ARY, Zivkovic T. Rethinking Restriction in Residential Aged Care: Dis/Abling Movement and Relations in the Time of COVID-19. SPACE AND CULTURE : THE JOURNAL 2023; 26:351-364. [PMID: 38602909 PMCID: PMC10008998 DOI: 10.1177/12063312231159227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Restricting movement is a major focus in policy directives to reduce the spread of COVID-19 in aged care homes. In this article, we rethink dominant framing of restriction through a critical examination of the politics of good care and ethnographic attention to spatial extensions and interdependencies between residents, care workers, and assistive technologies. Drawing on ethnographic observations in two South Australian care facilities, analysis of aged care policies and national inquiries into aged care, and relevant media reporting, we examine how restriction to movement, misconceptualized as a good form of care, has suppressed residents' physical and social needs and ruptured abling assemblages of resident mobility. We propose that walking alongside aged and frail residents offers new ways for thinking about care and re-abling relational approaches to care in times of crisis.
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16
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‘Ways of being’ in the domestic garden for people living with dementia: doing, sensing and playing. AGEING & SOCIETY 2023. [DOI: 10.1017/s0144686x22001489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Abstract
Domestic gardens represent a site for enacting embodied identity and social relationships in later life, and negotiating tensions between continuity and change. In the context of dementia, domestic gardens have significant implications for ‘living well’ at home, and for wider discussions around embodiment, relational selfhood and agency. Yet previous studies exploring dementia and gardens have predominantly focused on care home or community contexts. In light of this, the paper explores the role of domestic gardens in the everyday lives of people living with dementia and their households, using qualitative, creative methods. This includes filmed walking interviews and garden tours, diaries and sketch methods, involving repeat visits with six households in England. Findings are organised thematically in relation to different ‘ways of being’ in the garden: working in and doing the garden; being in and sensing; and playing, empowerment and agency. These different ‘ways of being’ are situated within relationships with household members, neighbours and non-human actors, including pets, wildlife and the materiality of the garden. Garden practices illustrate continuity, situated within embodied biographies and habitus. However, identities, practices and gardens are also subject to ongoing readjustment and reconstruction. The conclusion discusses implications for extending literature on gardens and later life, describing how social and material relationships in domestic gardens are renegotiated in the context of dementia, while highlighting opportunities for ‘play’, active sensing and agency. We also explore contributions to understandings of dementia, home and place, and implications for garden design and care practice.
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17
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Choral singing and dementia: Exploring musicality as embodied and relational accomplishment. J Aging Stud 2022; 63:101077. [DOI: 10.1016/j.jaging.2022.101077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 12/05/2022]
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18
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Just and inclusive end-of-life decision-making for long-term care home residents with dementia: a qualitative study protocol. BMC Palliat Care 2022; 21:202. [PMID: 36419147 PMCID: PMC9684772 DOI: 10.1186/s12904-022-01097-x] [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: 05/17/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Many people living with dementia eventually require care services and spend the remainder of their lives in long-term care (LTC) homes. Yet, many residents with dementia do not receive coordinated, quality palliative care. The stigma associated with dementia leads to an assumption that people living in the advanced stages of dementia are unable to express their end-of-life needs. As a result, people with dementia have fewer choices and limited access to palliative care. The purpose of this paper is to describe the protocol for a qualitative study that explores end-of-life decision-making processes for LTC home residents with dementia. METHODS/DESIGN This study is informed by two theoretical concepts. First, it draws on a relational model of citizenship. The model recognizes the pre-reflective dimensions of agency as fundamental to being human (irrespective of cognitive impairment) and thereby necessitates that we cultivate an environment that supports these dimensions. This study also draws from Smith's critical feminist lens to foreground the influence of gender relations in decision-making processes towards palliative care goals for people with dementia and reveal the discursive mediums of power that legitimize and sanction social relations. This study employs a critical ethnographic methodology. Through data collection strategies of interview, observation, and document review, this study examines decision-making for LTC home residents with dementia and their paid (LTC home workers) and unpaid (family members) care partners. DISCUSSION This research will expose the embedded structures and organizational factors that shape relationships and interactions in decision-making. This study may reveal new ways to promote equitable decision-making towards palliative care goals for LTC home residents with dementia and their care partners and help to improve their access to palliative care.
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19
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Russell C, Kohe GZ, Evans S, Brooker D. Rethinking Spaces of Leisure: How People Living with Dementia Use the Opportunities Leisure Centres Provide to Promote their Identity and Place in the World. INTERNATIONAL JOURNAL OF THE SOCIOLOGY OF LEISURE 2022. [PMCID: PMC9610313 DOI: 10.1007/s41978-022-00121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report on research that found joining activities within community leisure and fitness centres (Centres) enabled people living with dementia to create meaning about everyday life and foster identity. Focusing on three Centres in England, the study was informed by the experiences and accounts of four people living with dementia, their life-partner (if applicable) and the sports professional most closely associated with the person as each participated within a range of leisure opportunities. The methodology was underpinned by phenomenological philosophy and utilised participative methods. Theoretically, the paper draws upon considerations of serious leisure that provide ways in which the participants’ experiences could be understood and wider implications considered. Conceptual themes we derived from the data analysis were place, citizenship, and belonging (where the Centre acting as a physical space was important); identity and interaction (where the focus was upon space making and embodiment); safe spaces and care (i.e., how wellbeing was sustained and how participation and meaningful engagement occurred within the space); and, the value of Centres as opportunity structures (where all of these themes coalesced). Amid current public health debates over resourcing and care, this research provides timely insights and continued needed debates on the relationship between adequate social, economic and political support/resourcing, and the ability of Centres to facilitate and sustain meaningful and safe spaces. Beyond, we suggest our findings offer learning that might extend to wider contexts; for example, through including Centres within social care and health initiatives, where emphasis will be upon participation as a citizen rather than as a patient.
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Affiliation(s)
- Christopher Russell
- Association for Dementia Studies, University of Worcester, Henwick Grove, Worcester, WR2 6AJ UK
| | - Geoffery Z. Kohe
- School of Sport & Exercise Sciences, University of Kent, Chatham, UK
| | - Shirley Evans
- Association for Dementia Studies, University of Worcester, Henwick Grove, Worcester, WR2 6AJ UK
| | - Dawn Brooker
- Association for Dementia Studies, University of Worcester, Henwick Grove, Worcester, WR2 6AJ UK
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20
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Cook C, Henrickson M, Schouten V. Palliative Care, Intimacy, and Sexual Expression in the Older Adult Residential Care Context: "Living until You Don't". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13080. [PMID: 36293660 PMCID: PMC9603265 DOI: 10.3390/ijerph192013080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/22/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Commonly, frail older adults move to residential care, a liminal space that is their home, sometimes a place of death, and a workplace. Residential facilities typically espouse person-centred values, which are variably interpreted. A critical approach to person-centred care that focuses on social citizenship begins to address issues endemic in diminishing opportunities for intimacy in the end-of-life residential context: risk-averse policies; limited education; ageism; and environments designed for staff convenience. A person-centred approach to residents' expressions of intimacy and sexuality can be supported throughout end-of-life care. The present study utilised a constructionist methodology to investigate meanings associated with intimacy in the palliative and end-of-life care context. There were 77 participants, including residents, family members and staff, from 35 residential facilities. Analysis identified four key themes: care home ethos and intimacy; everyday touch as intimacy; ephemeral intimacy; and intimacy mediated by the built environment. Residents' expressions of intimacy and sexuality are supported in facilities where clinical leaders provide a role-model for a commitment to social citizenship. Ageism, restrictive policies, care-rationing, functional care, and environmental hindrances contribute to limited intimacy and social death. Clinical leaders have a pivotal role in ensuring person-centred care through policies and practice that support residents' intimate reciprocity.
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Affiliation(s)
- Catherine Cook
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand
| | - Mark Henrickson
- School of Social Work, Massey University, Auckland 0745, New Zealand
| | - Vanessa Schouten
- School of Humanities, Media and Communication, Massey University, Palmerston North 4442, New Zealand
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21
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Sullivan MP, Williams V, Grillo A, McKee-Jackson R, Camic PM, Windle G, Stott J, Brotherhood E, Crutch SJ. Peer support for people living with rare or young onset dementia: An integrative review. DEMENTIA 2022; 21:2700-2726. [PMID: 36114712 PMCID: PMC9583292 DOI: 10.1177/14713012221126368] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The aim of this integrative review was to identify and synthesize the
literature on peer support interventions for people living with or caring
for someone with a rare or young onset dementia. Design A literature search of articles was performed using the Nipissing University
Primo search system, a central index that enables simultaneous searches
across databases which included MEDLINE (PubMed), Web of Science, PsycINFO,
CINAHL, Sociological Abstracts, Cochrane Library. Results The eleven papers that met the inclusion criteria spanned eighteen years and
from five countries. Studies reported on peer support programs that were
either hospital-based (n = 6) or community-based (n = 4), and were
predominantly led by disciplines in the health sciences. Only one study did
not involve delivering services. There was a range of methodological quality
within the studies included in the review. Further analysis and synthesis
led to the identification of three overarching peer support themes. These
included: (1) peers as necessarily part of social support interventions; (2)
a theoretical portmanteau; and (3) dementia spaces and relationality. Conclusion Consistent with a much larger body of work examining peer involvement in
social interventions, this review reinforced the valuable contribution of
peers. A full understanding of the mechanisms of change was not achieved.
Notwithstanding, the issue of studies neglecting to sufficiently
conceptualize and describe interventions is an important one – drawing
attention to the need to continue to explore varied delivery, including
co-produced models, and more effective evaluation strategies to inform the
dementia care sector.
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Affiliation(s)
- Mary Pat Sullivan
- Faculty of Education and Professional Studies, Nipissing University, North Bay, ON, Canada
| | - Veronika Williams
- Faculty of Education and Professional Studies, Nipissing University, North Bay, ON, Canada
| | - Adetola Grillo
- Faculty of Education and Professional Studies, Nipissing University, North Bay, ON, Canada
| | - Roberta McKee-Jackson
- UCL Institute of Neurology, Dementia Research Centre, University College London, London, UK
| | - Paul M Camic
- UCL Institute of Neurology, Dementia Research Centre, University College London, London, UK
| | - Gill Windle
- Ageing and Dementia @ Bangor, Dementia Services Development Centre (DSDC), School of Health Sciences, Bangor University, Bangor, UK
| | - Joshua Stott
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Emily Brotherhood
- UCL Institute of Neurology, Dementia Research Centre, University College London, London, UK
| | - Sebastian J Crutch
- UCL Institute of Neurology, Dementia Research Centre, University College London, London, UK
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22
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Abstract
Although friendship is vital in later life, particularly amongst people who are living with dementia, little is known about how friendships are sustained following a diagnosis. Some research suggests that, because of dementia-related stigma, friendships dissolve following diagnosis; however, other researchers have shown that friendships can persist in dementia. The purpose of this article is to explore strategies that people with dementia and their friends (i.e., those who have been friends for at least 2 years) utilize to sustain their friendships. Following a constructivist approach, we interviewed people living with dementia, friends, and family members to better understand how friendships are maintained after a diagnosis of dementia. Data were analyzed using thematic analysis. An overarching theme, adapting to change, was generated. Participants adapted in several ways, including: (1) prioritizing friendship, (2) shifting ways of thinking about our friend/ship, and (3) addressing changes through practical strategies. These strategies helped maintain mutually beneficial, reciprocal friendships that were able to withstand changes that accompany a diagnosis of dementia.
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Affiliation(s)
- M Rebecca Genoe
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan
| | - Darla Fortune
- Department of Applied Human Sciences, Faculty of Arts and Sciences, Concordia University, Montreal, Quebec
| | - Colleen Whyte
- Department of Recreation and Leisure Studies, Brock University, Saint Catharines, Ontario
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23
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Huizenga J, Scheffelaar A, Fruijtier A, Wilken JP, Bleijenberg N, Van Regenmortel T. Everyday Experiences of People Living with Mild Cognitive Impairment or Dementia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10828. [PMID: 36078544 PMCID: PMC9518176 DOI: 10.3390/ijerph191710828] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Increasing attention has been paid to the 'voice' of people living with mild cognitive impairment (MCI) or dementia, but there is a lack of clarity about how everyday life is perceived from this insider's perspective. This study aimed to explore the everyday life experiences, challenges and facilitators of individuals with MCI and dementia living at home. A scoping review of qualitative studies, guided by the Joanna Briggs Institute Reviewers Manual, was conducted. Eight databases were searched, resulting in 6345 records, of which 58 papers published between 2011 and 2021 were included. Analysis was carried out by descriptive content analysis. Findings were categorized into seven spheres of everyday life: experiences related to the condition, self, relationships, activities, environment, health and social care and public opinions. The results show many disruptions and losses in everyday life and how people try to accommodate these changes. In all areas of everyday life, people show a deep desire to have reciprocal relationships, stay engaged through participation in activities and have a sense of belonging in the community. However, more research is needed on the factors that promote and impede the sense of reciprocity and belonging.
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Affiliation(s)
- Jacoba Huizenga
- Institute of Social Work, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Aukelien Scheffelaar
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Agnetha Fruijtier
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
| | - Jean Pierre Wilken
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Research Center Healthy & Sustainable Living, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Department Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Tine Van Regenmortel
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
- HIVA—Research Institute for Work and Society, Faculty of Social Sciences, University of Leuven, B-3000 Leuven, Belgium
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24
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Schweda M, Jongsma K. Death in Advance? A critique of the "Zombification" of people with dementia. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2022; 44:37. [PMID: 35972614 PMCID: PMC9380668 DOI: 10.1007/s40656-022-00512-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
This contribution sets out to criticize the prominent metaphor of "death while alive" in the context of dementia. We first explain the historical origin and development as well as the philosophical premises of the image. We then take a closer look at its implications for understanding dementia and societal attitudes and behaviours towards those affected. In doing so, we adopt a life course perspective that seeks to account for the ethical significance of the temporal extension and structure of human life. According to this perspective, individual existence in time is characterized by normative standards of age-appropriate behavior, evaluative standards of a good life, and teleological notions of successful development which require theoretical analysis and ethical discussion. Such a perspective can contribute significantly to spelling out the implications of the metaphor of death while alive and to criticizing their problematic aspects. Indeed, it makes clear that this metaphor aligns dementia with a different point in the human life course, thus ultimately framing it as a kind of deviation from the biographical norm, a disruption in an assumed temporal order of existence. At the same time, the life course perspective can help to understand why this conception involves ethically problematic distortions and blind spots. The resulting considerations allow conclusions with regard to medical and care ethical debates about self-determination, surrogate decision making, and advance directives in the context of dementia. Furthermore, on a theoretical-conceptual level, they also illustrate the importance of a biography- and culture-sensitive approach to philosophical and ethical reasoning in biomedicine and the life sciences.
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Affiliation(s)
- Mark Schweda
- Division of Medical Ethics, Department of Health Services Research, School for Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.
| | - Karin Jongsma
- Department of Medical Humanities , UMC Utrecht, Utrecht, The Netherlands
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25
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O'Connor D, Sakamoto M, Seetharaman K, Chaudhury H, Phinney A. Conceptualizing citizenship in dementia: A scoping review of the literature. DEMENTIA 2022; 21:2310-2350. [PMID: 35768395 PMCID: PMC9483710 DOI: 10.1177/14713012221111014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Citizenship has provided an important conceptual framework in dementia research
and practice over the past fifteen years. To date, there has been no attempt to
synthesize the multiple perspectives that have arisen in this literature. The
purpose of this paper is to explore, reflect on, and contrast, the key concepts
and trends in the citizenship discourse as it relates to people with dementia.
Using a scoping review methodology, forty-nine articles were identified for
review. Despite the use of different descriptors, thematic analysis revealed
four core themes underpinning citizenship discourse: 1) the relationality of
citizenship; 2) facilitated agency and autonomy; 3) attention to stigma,
discrimination and exclusion; and 4) recognition of the possibilities of
identity and growth. Overall, this scoping review found a major emphasis on
expanding definitions of agency and autonomy to render citizenship unconditional
and inclusive of the diverse life experiences of people living with dementia.
Notably, there is recognition that a more intersectional lens for embedding the
subjective experience within a broader socio-political context is needed. Whilst
the adoption of a citizenship lens in dementia research and practice has had
real-world implications for policy and research, its exploration and use
continue to be led by academics, highlighting the importance that future
research involve input form people with dementia.
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Affiliation(s)
- Deborah O'Connor
- School of Social Work, 8166University of British Columbia, Vancouver, BC, Canada
| | - Mariko Sakamoto
- Centre for Research on Personhood in Dementia, 8166University of British Columbia, Vancouver, BC, Canada
| | - Kishore Seetharaman
- Department of Gerontology, 1763Simon Fraser University, Vancouver, BC, Canada
| | - Habib Chaudhury
- Department of Gerontology, 1763Simon Fraser University, Vancouver, BC, Canada
| | - Alison Phinney
- School of Nursing, 8166University of British Columbia, Vancouver, BC, Canada
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26
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"It Makes You Feel Good to Help!": An Exploratory Study of the Experience of Peer Mentoring in Long-Term Care. Can J Aging 2022; 41:451-459. [PMID: 35538870 DOI: 10.1017/s0714980821000611] [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: 11/07/2022] Open
Abstract
Social isolation and loneliness in long-term care settings are a growing concern. Drawing on concepts of social citizenship, we developed a peer mentoring program in which resident mentors and volunteers formed a team, met weekly for training, and paired up to visit isolated residents. In this article, we explore the experiences of the resident mentors. As part of a larger mixed-methods study conducted in 10 sites in Canada, we interviewed mentors (n = 48) and analysed data using inductive thematic analysis. We identified three inter-related themes: Helping others, helping ourselves described the personal benefits experienced through adopting a helping role; Building a bigger social world encapsulated new connections with those visited, and; Facing challenges, learning together described how mentors dealt with challenges as a team. Our findings suggest that a structured approach to mentoring benefits residents and helps them feel confident taking on a role supporting their isolated peers.
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27
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Tieu M, Mudd A, Conroy T, Pinero de Plaza A, Kitson A. The trouble with personhood and person-centred care. Nurs Philos 2022; 23:e12381. [PMID: 35416420 DOI: 10.1111/nup.12381] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/04/2022] [Accepted: 02/05/2022] [Indexed: 12/30/2022]
Abstract
The phrase 'person-centred care' (PCC) reminds us that the fundamental philosophical goal of caring for people is to uphold or promote their personhood. However, such an idea has translated into promoting individualist notions of autonomy, empowerment and personal responsibility in the context of consumerism and neoliberalism, which is problematic both conceptually and practically. From a conceptual standpoint, it ignores the fact that humans are social, historical and biographical beings, and instead assumes an essentialist or idealized concept of personhood in which a person is viewed as an individual static object. From a practical standpoint, the application of such a concept of personhood can lead to neglect of a person's fundamental care needs and exacerbate the problems of social inequity, in particular for older people and people with dementia. Therefore, we argue that our understanding of PCC must instead be based on a dynamic concept of personhood that integrates the relevant social, relational, temporal and biographical dimensions. We propose that the correct concept of personhood in PCC is one in which persons are understood as socially embedded, relational and temporally extended subjects rather than merely individual, autonomous, asocial and atemporal objects. We then present a reconceptualization of the fundamental philosophical goal of PCC as promoting selfhood rather than personhood. Such a reconceptualization avoids the problems that beset the concept of personhood and its application in PCC, while also providing a philosophical foundation for the growing body of empirical literature that emphasizes the psychosocial, relational, subjective and biographical dimensions of PCC.
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Affiliation(s)
- Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,College of Arts Humanities and Social Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Alexandra Mudd
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Alejandra Pinero de Plaza
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
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28
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Huang Y, Cong Y, Wang Z. Rethinking the Precedent Autonomy, Current Minimal Autonomy, and Current Well-Being in Medical Decisions for Persons with Dementia. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:163-175. [PMID: 35015243 DOI: 10.1007/s11673-021-10159-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/03/2021] [Indexed: 06/14/2023]
Abstract
As patient autonomy expands, a highly controversial issue has emerged. Should the advance directives (ADs) of refusing life-saving treatments or requesting euthanasia of persons with dementia (PWDs) who express changed minds or are often in a happy state be fulfilled? There are two autonomy-related positions. The mainstream position in philosophical discussions supports the priority of ADs based on precedent autonomy. Buchanan and Brock, and Dworkin represent this view. The other position supports the priority of PWDs' current wishes based on minimal autonomy represented by Jaworska. By rethinking the theoretical and practical challenges of the two positions and their arguments respectively, the paper concludes that in such a scenario, the priority of ADs is morally indefensible, and it is also challenging to establish minimal autonomy defend the moral priority of PWDs' current wishes. For PWDs whose past values, beliefs, and preferences fade away but who retain apparent intrinsic sentience of well-being, a modified defined quality-of-life (QoL) approach serves as another reasonable basis in their medical decision-making, and the ADs and the QoL should be further merged to reduce the uncertainty of the grey zone.
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Affiliation(s)
- Yuanyuan Huang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, China
- School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Yali Cong
- The Department of Medical Ethics and Law, Peking University Health Science Center, Beijing, 100191, China
| | - Zhifeng Wang
- School of Public Health, Peking University Health Science Center, Beijing, 100191, China.
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Niedderer K, Holthoff-Detto V, van Rompay TJ, Karahanoğlu A, Ludden GD, Almeida R, Durán RL, Aguado YB, Lim JN, Smith T, Harrison D, Craven MP, Gosling J, Orton L, Tournier I. This is Me: Evaluation of a boardgame to promote social engagement, wellbeing and agency in people with dementia through mindful life-storytelling. J Aging Stud 2022; 60:100995. [DOI: 10.1016/j.jaging.2021.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/12/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
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Ciofi JM, Kemp CL, Bender AA. Assisted Living Residents with Dementia: Being Out in the World and Negotiating Connections. THE GERONTOLOGIST 2021; 62:200-211. [PMID: 34370003 DOI: 10.1093/geront/gnab113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Persons living with dementia, including long-term care residents, and their care partners emphasize the importance of meaningful engagement and stress the need for activity and opportunities to go outdoors or offsite. Yet, little is known about getting out in this population. Here, our objectives are to: 1) identify residents' opportunities for, and experiences with, getting out; 2) understand the significance of getting out; and 3) explain influential factors. RESEARCH DESIGN AND METHODS Guided by grounded theory methods, we analyzed qualitative data collected over a one-year period in four diverse assisted living communities. We followed 33 residents with dementia and their care partners. Data include detailed fieldnotes capturing 1,560 observation hours, 114 interviews with residents (where possible), assisted living staff, family members, and other visitors, and record review. RESULTS We identified the centrality of "being out in the world and negotiating connections," which characterizes residents' experiences with the outside world as a process of 'working out' engagement with nature, others, and the community. Being out in the world was consequential to well-being and quality of life. Most residents got out at least occasionally; some lacked opportunities. Among residents who got out, most benefitted from ensuing connections. Yet, not all experiences were positive. Being out in the world varied over time and by individual-, convoy-, AL community-, and neighborhood-level factors. DISCUSSION AND IMPLICATIONS We discuss the implications of our findings for research and practice surrounding meaningful engagement among persons with dementia, including during crises such as the pandemic.
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Affiliation(s)
- Joy M Ciofi
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
| | - Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA.,Department of Sociology, Georgia State University, Atlanta, Georgia, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Emory School of Medicine, Atlanta, Georgia, USA
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Jonas-Simpson C, Mitchell G, Dupuis S, Donovan L, Kontos P. Free to be: Experiences of arts-based relational caring in a community living and thriving with dementia. DEMENTIA 2021; 21:61-76. [PMID: 34166151 PMCID: PMC8739588 DOI: 10.1177/14713012211027016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To present findings about experiences of relational caring at an arts-based academy for persons living with dementia. BACKGROUND There is a compelling call and need for connection and relationships in communities living with dementia. This study shares what is possible when a creative arts-based academy for persons living with dementia grounded in relational inquiry and caring focuses on relationships through the medium of the arts. DESIGN A qualitative phenomenological methodology (informed by van Manen) was used to answer the research question, "What is it like to experience relational caring at an arts-based academy for persons living with dementia?" We address two research objectives: (1) to explore how relationships are experienced when a relational caring philosophy underpins practice, including arts-based engagements; and (2) to understand the meaning of relationships that bring quality to day-to-day living. METHODS Twenty-five participants were recruited from the Academy and interviewed in one-to-one in-depth interviews or small groups. Participants included five persons living with dementia, eight family members, four staff, five artists, one personal support worker, and two volunteers. Participants were asked to describe their experiences of relational caring or relationships in the Academy space. FINDINGS Three thematic patterns emerged, which address the research objectives.Relational caring is experienced when:freedom and fluid engagement inspire a connected spontaneous liveliness;embracing difference invites discovery and generous inclusivity; andmutual affection brings forth trust and genuine expression. CONCLUSIONS Findings contribute to the growing body of knowledge about both relational caring and arts-based practices that call forth a different ethic of care-one that is relational, inclusive, and intentional. Findings also shed light on what is possible when a relational caring philosophy underpins arts-based practices-everyone thrives.
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Affiliation(s)
| | | | | | - Lesley Donovan
- St. Michael's Hospital, 508783Unity Health Toronto, Toronto, ON, Canada
| | - Pia Kontos
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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32
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Art, authenticity and citizenship for people living with dementia in a care home. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
This paper reports on a study which examined the notions of authenticity and citizenship for people living with cognitive impairment or dementia in a care home in the North-East of England. We demonstrated that both notions were present and were encouraged by engagement with an artist, where this involved audio and visual recordings and the creation of a film. The artist's interactions were observed by a non-participant observer using ethnographic techniques, including interviews with the residents, their families and the staff of the care home. The data were analysed using grounded theory and the constant comparative method of qualitative analysis. Our findings suggest that participatory art might help to maintain and encourage authenticity and citizenship in people living with dementia in a care home. Certainly, authenticity and citizenship are notions worth pursuing in the context of dementia generally, but especially in care homes.
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Motta-Ochoa R, Incio Serra N, Frantz A, Blain-Moraes S. Enacting agency: movement, dementia, and interaction. Arts Health 2021; 14:133-148. [PMID: 33651673 DOI: 10.1080/17533015.2021.1894464] [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] [Indexed: 10/22/2022]
Abstract
Background: Arts-based programs can counter the dominant narrative of loss associated with dementia, in part through fostering expressions of agency. This study uses social science theories of interaction between structure and agency to examine how an arts-based movement program, entitled Mouvement de passage, supports agency among individuals with dementia. Methods: Ethnographic methods were used to trace how participants enact agency within the structure of the movement program. The program's sessions were video recorded and iteratively analyzed. Results: Participants expressed their agency in three ways: 1) transforming the exercise's structure according to individual interests and desires; 2) resisting the exercise's structure; and 3) improvising movements collectively. Conclusions: The movements of individuals with dementia were shaped by both program structure and individual/collective expressions of agency. The design of Mouvement de passage, based on open-ended structures and voluntary participation, provides a template for developing interventions that foster agency among these persons.
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Affiliation(s)
- Rossio Motta-Ochoa
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec.,Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital, Montreal, Quebec
| | - Natalia Incio Serra
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec.,Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital, Montreal, Quebec
| | - Allison Frantz
- Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital, Montreal, Quebec.,Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital Integrated Program in Neuroscience, McGill University, Montreal, Quebec
| | - Stefanie Blain-Moraes
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec.,Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital, Montreal, Quebec
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Newton R, Keady J, Tsekleves E, Adams OBE S. ‘My father is a gardener … ’: A systematic narrative review on access and use of the garden by people living with dementia. Health Place 2021; 68:102516. [DOI: 10.1016/j.healthplace.2021.102516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
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Kemp CL. #MoreThanAVisitor: Families as "Essential" Care Partners During COVID-19. THE GERONTOLOGIST 2021; 61:145-151. [PMID: 33295960 PMCID: PMC7799094 DOI: 10.1093/geront/gnaa161] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 11/30/2022] Open
Abstract
The public health response to the current Coronavirus pandemic in long-term care communities, including assisted living, encompasses prohibiting visitors. This ban, which includes family members, has been criticized for being unfair, unhealthy, and unsafe. Against this backdrop, I examine the roles family play in residents' daily lives and care routines. I argue that classifying family as "visitors" rather than essential care partners overlooks their critical contributions and stems from taken-for-granted assumption about gender, families, and care work, and I demonstrate why families are more than visitors. Policies that ban family visits also reflect a narrow understanding of health that focuses on mitigating infection risk, but neglects overall health and well-being. This policy further stems from a limited comprehension of care relations. Research shows that banning family visits has negative consequences for residents, but also families themselves, and direct care workers. I argue that identifying ways to better understand and support family involvement is essential and demonstrate the utility of the Convoys of Care model for guiding the reconceptualization of family in long-term care research, policy, and practice during and beyond the pandemic.
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Affiliation(s)
- Candace L Kemp
- The Gerontology Institute and Department of Sociology, Georgia State University, Atlanta, USA
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Herron RV, Funk LM, Spencer D. Stories of violence and dementia in mainstream news media: Applying a citizenship perspective. DEMENTIA 2020; 20:2077-2090. [PMID: 33337247 DOI: 10.1177/1471301220981232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, we analyze how mainstream news media frames violence in relation to dementia and the consequences of different frames for people living with dementia and their carers. Conceptually, the goal is to bring literature on citizenship and aggression into dialog with each other. Empirically, a total of 141 regional and national English-language mainstream Canadian news media articles (2008-2019) with a focus on dementia, violence, and aggression were analyzed. Analytically, we examine how different actors are portrayed as victims or perpetrators; how their histories (identities, belonging, and exclusion) are told; how dementia is used to explain events; and what types of expert knowledge and authorities are introduced to make sense of stories of violence in relationships of care. Our analysis points to the implications of media narratives for people with dementia as well as carers and researchers seeking to address stigma and call for change.
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Affiliation(s)
- Rachel V Herron
- Department of Geography and Environment, 1916Brandon University, Canada
| | - Laura M Funk
- Department of Sociology and Criminology, 8664University of Manitoba, Canada
| | - Dale Spencer
- Department of Law and Legal Studies, 6339Carleton University, Canada
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New analytical tools and frameworks to understand dementia: what can a human rights lens offer? AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20001506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
The biomedical model has traditionally informed the dominant discourse on dementia and has significantly shaped practitioners’, policy makers’ and researchers’ responses. This model contextualises dementia as a progressive neuro-degenerative cognitive disorder and focuses on deficits and underlying pathology, often overlooking the fact that the person can and should be an active partner in the treatment process. Beginning in the late 1990s, the exclusive reliance on the bio-medical model has come under increasing scrutiny with a growing awareness that by recasting dementia in broader social and more humanitarian terms, much can be done to promote the individual's quality of life. Different frameworks and analytical tools have been forwarded to help us better understand dementia. These include personhood, citizenship, public health, disability and human rights. This review examines the merits of framing dementia as a disability, a citizenship concern and a human rights issue. It highlights some of the potential gains that can arise for the individual in using a human rights model to enhance practice, inform policy and create a more balanced research agenda. The article concludes by arguing that the complexities and magnitude of dementia are such that it requires multiple responses and a broad range of interpretative frameworks.
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Abstract
Drawing on data from fieldwork in a Norwegian care home for people diagnosed with dementia, the article focuses on how social ordinariness is produced by professional practices and co-operation with residents. Through the lens of ethnomethodological and other pragmatist approaches to ordinariness, social agency and identity, the article uses interviews and observations to explore how residents in a care home were given the opportunity to act as ordinary persons and maintain ordinariness despite their illness. The analysis shows that a social and moral norm of ordinariness was central for how professional care work was performed in the care home. To help residents maintaining ordinariness was an essential part of caring work and to accomplish this, residents were regularly involved in activities they recognised from their everyday lives. This helped them holding on to their identities. The activities were regulated by situational rules that avoided stigmatising behaviour and maintained the residents' dignity.
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Affiliation(s)
- Trude Gjernes
- Faculty of Social Sciences, Nord University, Bodø, Norway
| | - Per Måseide
- Faculty of Social Sciences, Nord University, Bodø, Norway
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Strøm BS, Engedal K. Ethical aspects in dementia care - The use of psychosocial interventions. Nurs Ethics 2020; 28:435-443. [PMID: 34032153 DOI: 10.1177/0969733020952121] [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] [Indexed: 11/17/2022]
Abstract
The use of psychosocial interventions for people with dementia is common and recommended because they focus on the underlying problem and well-being of the person. The promotion of well-being is a relevant dimension in person-centred care, where the aim is to confirm the person's 'personhood'. Most literature about ethics in dementia care instructs us on how and when to include people with dementia in our research. Little is written about the ethical aspects regarding the use of psychosocial interventions in daily care. In clinical practise, several challenges arise about the use of psychosocial interventions. Those include questions about the person's ability to participate in decision-making and how we know what is best for them. Furthermore, we must consider what kinds of psychosocial interventions are best for everybody, or if intervention causes discomfort for the person. This article emphasizes the necessity to consider the ethical aspects of the implementation of psychosocial interventions while taking into consideration the persons individual needs. A particular ethical challenge arises when a person with dementia is unable to express themselves verbally. Therefore, it is essential that the staff know the history and preferences of each person with dementia. The ethical aspects of psychosocial interventions for people with dementia will be discussed using Beauchamp and Childress four ethical principles: respect for autonomy, beneficence, non-maleficence and justice. The person-centred approach proposed by Kitwood's and Brooker.
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Affiliation(s)
| | - Knut Engedal
- Vestfold Hospital HF, Norway; Oslo University Hospital, Norway
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40
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Mmako NJ, Courtney-Pratt H, Marsh P. Green spaces, dementia and a meaningful life in the community: A mixed studies review. Health Place 2020; 63:102344. [PMID: 32543430 DOI: 10.1016/j.healthplace.2020.102344] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 11/15/2022]
Abstract
Engagement in green spaces impacts positively on wellbeing and quality of life. However, little is known about the impacts of green space engagement specifically for people living with the experience of dementia in the community; people with a heightened need to maintain a quality life. In this mixed study review, we explore existing evidence for quality of life impacts of contact with green spaces by people living with dementia in the community. Findings show that gardens and horticultural programs, green care farms, parks, urban woodlands and neighbourhood outdoor environments can impact positively in several ways. Four key mechanisms are identified: Engaging in meaningful activities; Empowerment; Positive risk taking; and Reinforcing Identity. These findings provide conceptual links between psychosocial understandings of the relationships between nature and wellbeing with rights-based dementia discourses. We conclude that evidence specific for people living with dementia in the community setting is growing and there is potential for green spaces to enable an active and meaningful community-life, despite cognitive decline. This is worthy of consideration by policy makers, practitioners and carers. Future studies can broaden this field of research and include investigations into lesser-explored aspects of quality of life, such as spirituality, and methods that incorporate the voices of people living with dementia.
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Affiliation(s)
- Nkolika Janet Mmako
- Wicking Dementia Research & Education Centre, University of Tasmania, Private Bag 143, Hobart, Tasmania, 7001, Australia.
| | - Helen Courtney-Pratt
- Wicking Dementia Research and Education Centre, University of Tasmania, Private Bag 143, Hobart, 7001, Australia.
| | - Pauline Marsh
- Centre for Rural Health, University of Tasmania, Private Bag 103, Hobart, Tasmania, 7001, Australia.
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"If you do not find the world tasty and sexy, you are out of touch with the most important things in life": Resident and family member perspectives on sexual expression in continuing care. J Aging Stud 2020; 53:100849. [PMID: 32487340 DOI: 10.1016/j.jaging.2020.100849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 11/20/2022]
Abstract
Over the past three decades, there has been growing attention to sexual expression in continuing care homes. However, resident perspectives continue to be underrepresented, particularly in the Canadian context. In this article, we share findings from a qualitative, exploratory study looking at the experiences of residents and family members in Alberta, Canada. As continuing care demographics and social norms about sexuality shift, it is increasingly important to understand these perspectives. We asked participants about how they define sexual expression, its place in continuing care, their experiences with/thoughts about sexual expression in care homes, and suggestions for how to improve this aspect of resident life. We heard diverse accounts of what sexual expression can look like in continuing care homes, the importance of resident autonomy, how privacy matters, complex communication dynamics, and challenges with distinguishing between appropriate and inappropriate expressions. These findings foreground the voices of residents and family members and highlight key areas of opportunity for policy and practice change.
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Kim S, Chee KH, Gerhart O. Generativity in Creative Storytelling: Evidence From a Dementia Care Community. Innov Aging 2020; 4:igaa002. [PMID: 32258435 PMCID: PMC7102510 DOI: 10.1093/geroni/igaa002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives Creative group storytelling as utilized in TimeSlips is a social activity that focuses on communication, improvisation, and creativity among its participants with dementia. A collective narrative is a channel through which participants express themselves, and it thus signifies clues about their identities, values, and experiences. No study to date, however, has examined the contents of the stories. Using the generativity model as a theoretical underpinning for analysis, this paper examines the emergent themes of such collective stories. Research Design and Methods This study used the data collected in a memory care community where a research team recruited and engaged 21 out of approximately 80 residents with dementia in 6 weekly creative storytelling sessions; 4 small groups of 4 to 6 participants created a total of 24 collective stories. Three researchers analyzed these stories by open-coding emergent themes. Once coded manually, the narratives were managed and analyzed in NVivo. Results Consistent with the concept of generativity, a thematic analysis of collective narratives revealed various aspects of participants’ generative concerns. Three themes related to generativity: (1) caring and promoting the well-being of others, (2) family values, and (3) positivity. Discussion and Implications The narratives show that participants living with dementia continue to express their generative values and concerns. The findings reveal generative identities held by persons living with dementia, which help destigmatize dementia. The findings also shed light on why creative group storytelling may affect multiple positive outcomes for its participants.
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Affiliation(s)
- Seoyoun Kim
- Department of Sociology, Texas State University, San Marcos
| | - Kyong Hee Chee
- Department of Sociology, Texas State University, San Marcos
| | - Olga Gerhart
- Department of Philosophy, Texas State University, San Marcos
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Mitra S, Schicktanz S. Alzheimer's Patient Organizations' Role in Enabling Citizenship Projects: A Comparison of the USA, Germany, and the UK. FRONTIERS IN SOCIOLOGY 2020; 5:19. [PMID: 33869428 PMCID: PMC8022661 DOI: 10.3389/fsoc.2020.00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/04/2020] [Indexed: 06/12/2023]
Abstract
This paper examines how Alzheimer's disease (AD) patient support organizations (POs) located in diverse healthcare regimes enable patients to claim and construct their rights as citizens. Since citizenship rights of people with AD are debated widely, it is important to recognize the role of POs in enabling people to construct citizenship identities. This paper thus examines the factors that shape the citizenship projects of the AD POs. Since collective health-related behavior changes in line with national differences, we compare the biggest AD POs in three starkly distinct healthcare regimes: the Alzheimer's Association in the US (ALZ), the Deutsche Alzheimer Gesellschaft (German Alzheimer's Association) in Germany (DAG), and Alzheimer's Society in the UK (AS), to examine how distinct health policy contexts shape their citizenship projects. Based on our website analysis of the three POs and other related secondary documents, we argue that the way each POs work toward enabling its members to claim rights and assume responsibilities depend upon the nature of healthcare funding and resource allocation for AD care. Since AD involves long-term care, the ways in which the three POs enable the people with AD to secure their care expenses set apart the nature of citizenships enactments.
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Affiliation(s)
- Sayani Mitra
- Department for Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
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Gallagher E, Beard RL. Buffer or Blade: Perceived relationship closeness in couples navigating Alzheimer's. J Aging Stud 2020; 52:100832. [DOI: 10.1016/j.jaging.2020.100832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/28/2019] [Accepted: 01/03/2020] [Indexed: 11/29/2022]
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Francis LE, Lively KJ, König A, Hoey J. The Affective Self: Perseverance of Self-Sentiments in Late-Life Dementia. SOCIAL PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1177/0190272519883910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The self has long been construed as a rational, cognitive construct; the cognitive decline of dementia has therefore been largely viewed as the loss of self. Through qualitative interviews, we find that persons with dementia strive to maintain a coherent self despite their increasing disability. Using the theories of affect control theory (ACT) and ACT-Self, we illustrate their shift from using denotative (cognitive) meanings to reliance on connotative (affective) meanings in defining the situation and choosing identities to enact. As persons with dementia lose the cognitive ability to access shared definitions and reflected appraisals, their connection to the social world narrows to affective meanings of established sentiments and emotional reactions from others. Our findings underscore the creative agency of self and the limitations of the rationalistic bias of sociology by recognizing an affective self that stands in complement to the generally acknowledged cognitive self.
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Affiliation(s)
| | | | | | - Jesse Hoey
- University of Waterloo, Waterloo, Canada
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Sexual Expression in Alberta's Continuing Care Homes: Capacity, Consent, and Co-decision-making. Can J Aging 2020; 40:156-165. [PMID: 31973789 DOI: 10.1017/s0714980819000813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In this article, we explore the role of substitute decision-makers (SDMs) in matters of sexual expression for continuing care residents with diminished cognitive capacity. We examine how Alberta's current use of SDMs can enable an "all-or-none" approach to competence, wherein a person either has capacity to make all decisions or is incapable of making any. Three factors facilitate an environment in which this approach can influence residents' sexual expression. These include the wording of current legislation, lack of resources for SDMs, and relational dynamics between SDMs and care staff. We provide a critical review of existing legislation and empirical evidence of its challenges in practice. Though we focus on the Alberta context, there is reason to believe that similar issues persist in other Western jurisdictions. We offer several recommendations for how we can better support residents' sexual autonomy in continuing care and avoid pitfalls of the "all-or-none" approach to competence.
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Calvert L, Keady J, Khetani B, Riley C, Swarbrick C. ‘… This is my home and my neighbourhood with my very good and not so good memories’: The story of autobiographical place-making and a recent life with dementia. DEMENTIA 2019; 19:111-128. [DOI: 10.1177/1471301219873524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As part of the wider Neighbourhoods and Dementia Study, co-researchers from the Open Doors Research Group (based in Salford, UK) produced a series of three films with the title ‘The Changing Face of our Neighbourhood’. These films were subsequently placed on ‘YouTube’ and document co-researchers’ storied experiences of Salford and the industrial, economic and social changes that have occurred over the inquiry group’s lifetime. Drawn directly from this autobiographical and socio-generational work, this article focuses on the experience of lead author Lesley Calvert, who was diagnosed with dementia in 2013 and has been a member of the Open Doors Research Group since 2014. Lesley grew up and worked as a district nurse for almost 40 years, remaining close to her place of birth in Salford all her life. In this article, Lesley draws upon her autobiographical narrative which she shares in the three films to describe the intersections between biography, place-making, belonging and dementia. The article concludes with the importance of democratising the research space and why academic researchers need to create opportunities for personal stories to be told, heard and acted upon.
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Affiliation(s)
- Lesley Calvert
- Open Doors, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - John Keady
- Dementia and Ageing Research Team, Division of Nursing, Midwifery and Social Work, The University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, UK
| | | | | | - Caroline Swarbrick
- Centre for Ageing Research, Division of Health Research, Lancaster University, UK
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Sinclair C, Gersbach K, Hogan M, Blake M, Bucks R, Auret K, Clayton J, Stewart C, Field S, Radoslovich H, Agar M, Martini A, Gresham M, Williams K, Kurrle S. "A Real Bucket of Worms": Views of People Living with Dementia and Family Members on Supported Decision-Making. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:587-608. [PMID: 31832863 PMCID: PMC6937221 DOI: 10.1007/s11673-019-09945-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six interviews (twenty-one dyadic and fifteen individual) were undertaken with fifty-seven participants (twenty-five people living with dementia and thirty-two family members) across three states in Australia. Interpretative Phenomenological Analysis (IPA) was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants' experiences with decision-making: "the person in relationship over time" and "maintaining involvement." Participant views on the practical issues associated with supported decision-making are addressed under the themes of "facilitating decision-making," "supported decision-making arrangements," "constraints on decision-making," and "safeguarding decision-making." While participants endorsed the principles of supported decision-making as part of their overarching strategy of "maintaining involvement" in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual "constraints on decision-making" also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a "spectrum approach" to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population.
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Affiliation(s)
- Craig Sinclair
- Rural Clinical School of Western Australia, University of Western Australia Albany Centre, 31 Stirling Terrace, Albany, Western Australia, 6330, Australia.
| | - Kate Gersbach
- Brightwater Group, 3/355 Scarborough Beach Road, Osborne Park, Western Australia, 6017, Australia
| | - Michelle Hogan
- Helping Hand Aged Care, 34 Molesworth Street, North Adelaide, South Australia, 5006, Australia
| | - Meredith Blake
- UWA Law School, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Romola Bucks
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, University of Western Australia Albany Centre, 31 Stirling Terrace, Albany, Western Australia, 6330, Australia
| | - Josephine Clayton
- HammondCare Centre for Learning & Research in Palliative Care and Northern Clinical, School, Greenwich Hospital, University of Sydney, Sydney, New South Wales, 2065, Australia
| | - Cameron Stewart
- University of Sydney Law School, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Sue Field
- UWA Law School, University of Western Australia, Hackett Drive, Crawley, Western Australia, 6009, Australia
| | - Helen Radoslovich
- Helping Hand Aged Care, 34 Molesworth Street, North Adelaide, South Australia, 5006, Australia
| | - Meera Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, (IMPACCT), University of Technology Sydney, 235 Jones Street, Ultimo, New South Wales, 2007, Australia
| | - Angelita Martini
- Brightwater Group, 3/355 Scarborough Beach Road, Osborne Park, Western Australia, 6017, Australia
| | - Meredith Gresham
- HammondCare Dementia Centre, 97 River Road, Greenwich, New South Wales, 2065, Australia
| | - Kathy Williams
- Dementia Australia Consumer Dementia Network, National Office, 42 MacQuarie Street, Barton, Canberra, Australian Capital Territory, 2600, Australia
| | - Sue Kurrle
- Northern Clinical School, University of Sydney, Sydney, New South Wales, 2006, Australia
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49
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Kennedy L, Wilkinson H, Henstridge C. 'Buddy Pairs': A novel pilot scheme crafting knowledge exchange between biomedical dementia researchers and people affected by dementia - Innovative practice. DEMENTIA 2019; 20:381-390. [PMID: 31718269 DOI: 10.1177/1471301219885543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 'Buddy Pairs' pilot project, launched at the University of Edinburgh, created opportunities for people affected by dementia (people living with a diagnosis and care partners) and dementia lab researchers to participate in knowledge exchange conversations through experiential lab tours. The primary aims were to raise awareness and understanding of current dementia research and its practices, as well as allow biomedical researchers to learn about the lived experiences and research concerns of those affected by dementia. This scheme found success by flipping normative 'speaker-audience' communication set-ups and foregrounding the expertise held by, and communication needs of, people affected by dementia.
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Affiliation(s)
| | - Heather Wilkinson
- Edinburgh Centre for Research on the Experience of Dementia (ECRED), University of Edinburgh, UK
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50
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Haeusermann T. Forced continuity: Explorations of biographical narratives in dementia care. J Aging Stud 2019; 49:1-8. [PMID: 31229213 DOI: 10.1016/j.jaging.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 02/10/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Tobias Haeusermann
- Memory and Aging Center, UCSF, 1500 Owens St #320, San Francisco, CA 94158, USA; University of Cambridge, PPSIS Faculty, Department of Sociology, Free School Lane, Cambridge CB2 3, UK.
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