The coping experiences of spouses of persons with dementia

Associated factors of discrepancy between older adults and their family caregivers in reporting elder abuse

AIMS AND OBJECTIVES

This study focuses on elder abuse against older adults with mild-to-moderate cognitive and physical impairment who were receiving family care in Chinese context. Specifically, the study examined the associated factors of discrepancy between family caregiver and care recipient reports of elder abuse committed by the caregivers.

BACKGROUND

Many studies identified the discrepancies between caregivers and care recipients reports of elder abuse, but they did not examine factors contributing to such discrepancies. Various cultural factors may contribute to the accuracy of elder abuse reports.

METHODS

A consecutive sample of 1,002 older adults with mild-to-moderate cognitive and physical impairment and their family caregivers was surveyed.

DESIGN

Quantitative study with cross-sectional design.

RESULTS

Moderate-to-substantial agreement in caregiver and care recipient reports was found for all forms of abuse (Cohen's kappa = 0.39 to 0.76). Care recipient reports consistently generated higher rates than caregiver reports for psychological abuse (51.1% vs. 42.8%), physical abuse (1.2% vs. 1.0%), caregiver neglect (65.0% vs. 50.2%) and financial exploitation (40.8% vs. 34.2%). Similar factors were found for dyadic discrepancy in the reporting of various forms of elder abuse, which included desire to gain face, fear of losing face and sense of familism in the caregivers, as well as older age, cognitive impairment and female gender of the care recipient. This study was presented in adherence to the Strobe Checklist.

CONCLUSIONS

The results suggest that family caregivers might not be reliable as the sole informants to report their care recipients' victimization experiences. Information from multiple parties should be gathered and synthesized to obtain more accurate reporting of the frequency and severity of elder abuse. Meanwhile, cultural factors should be taken into account when seeking information related to elder abuse.

RELEVANCE TO CLINICAL PRACTICE

There is a need for multiple parties to provide and report information about the elder abuse. It is also need to consider cultural factors when detecting and intervening elder abuse.

A qualitative study of dementia caregivers' lived experiences in Singapore

Globally, the number of people living with dementia is expected to triple by 2050 owing primarily to the aging population. Dementia is a chronic and progressive disease that affects an estimated 5-8% of the general population aged 60 and above at any given time. This qualitative study aimed to investigate caregivers' overall perceptions, challenges, and coping strategies in dementia care in Singapore. Purposive sampling was used to select the study's sample. Eight Singaporeans were interviewed in semi-structured, in-depth interviews. Three themes emerged from the data analysis for each research question: overall perceptions (i.e. less freedom, strained family relationships, and improved self-competency), challenges (i.e. managing dementia symptoms, emotional drain, and decision-making), and coping mechanisms (i.e. making time for myself, religious belief, and seeking external support). Knowing about these challenges and coping mechanisms allows practitioners to help caregivers to reduce personal struggles, thus improving the patient's and caregiver's quality of life.

Antidepressant Effects of a Multimodal Group Therapy Program for Mild Dementia: A Retrospective Evaluation of Clinical Routine Data

BACKGROUND

The multimodal CORDIAL treatment concept for mild dementia, combining cognitive rehabilitation, cognitive behavioral and humanistic psychology interventions, has proven its feasibility and demonstrated a reduction of depressive symptoms in individual dyadic/triadic settings.

OBJECTIVE

We investigate antidepressant effects of an adapted group-based CORDIAL program in clinical routine care.

METHODS

During 2013 and 2017, 51 outpatients with mild dementia (45% female, mean age 72.4 years, 67% Alzheimer's dementia, mean MMST 24.8) periodically received a modified CORDIAL group treatment as part of our regular outpatient care. Treatment comprised 10 bi-weekly sessions, partly involving caregivers. Systematic pre- and post-treatment assessments of clinical routine data were evaluated retrospectively (median time-interval of 6.6 months).

RESULTS

Depressive symptoms as measured by the Geriatric Depression Scale significantly decreased over time (p = 0.007, Cohen's d = 0.39), and irrespective of gender. Patients with longer disease duration before treatment start showed significantly higher initial levels of depressive symptoms (p = 0.044), followed by a reduction to a level of those with shorter disease duration (ns). Most secondary outcomes (cognitive symptoms, disease severity, quality of life, caregiver burden) remained unchanged (ns), while competence in activities of daily living declined from pre- to post-measurement (p = 0.033).

CONCLUSION

A group-based CORDIAL treatment is feasible in a clinical routine setting and demonstrated antidepressant effects comparable to those of the individual treatment design, further suggesting its implementation in regular care. Future trials might also investigate its potentially preventive effects by reducing depressive symptoms in pre-dementia stages, even at a subsyndromal level.

Support and Empowerment for Older Adult Spousal Caregiving of People with Mild and Moderate Dementia: A Participatory Action Research

Background: Little attention has been given to the older adult caregivers of spouses with mild and moderate dementia in the caring dynamics process. The aim of this action research was to develop a program for providing support and empowerment to older adult caregivers of spouses with mild and moderate dementia in the community. Methods: The researchers acted as facilitators, with a view to empowering participants. We recruited participants from a day-care center and two community service stations. Data were collected with semi-structured, in-depth interviews with 19 dementia care dyads and from the notes, reflections, and feedback of collaborative researchers. Relevant themes for content analysis were extracted. Results: Three action cycles were completed over 18 months. The results revealed goals of three cycles: to connect the home situation and effective dialogue as a bridge to the researcher, to confirm the daily needs or expectations of the caregiver and the patient, and to enhance the interactions and quality of life of family members with resources and network. This process was cyclical and repetitive, and it also generated partnerships that built relationships among the interdisciplinary team, families, and researchers. At the same time, team workers formed a cooperative and coordinated family service mechanism to reflect the professional values and practice capabilities. Conclusions: The intervention program was based on the promotion of factors for the caregiver, linking to environmental protective factors, and the stabilization of mental and neurological symptoms of dementia patients, thereby enhancing the response capabilities of home caregivers while meeting the patient’s care needs in life. It is a tool that can effectively be used for support and empowerment in this population.

Managing depressive symptoms in people with mild cognitive impairment and mild dementia with a multicomponent psychotherapy intervention: a randomized controlled trial

OBJECTIVE

To evaluate the feasibility and effectiveness of the CORDIAL program, a psychosocial intervention consisting of cognitive behavioral therapy (CBT), cognitive rehabilitation, and reminiscence to manage depressive symptoms for people with mild cognitive impairment (MCI) or dementia.

DESIGN

We conducted a randomized controlled trial, based on a two-group (intervention and control), pre-/post-intervention design.

SETTING

Participants were recruited from five different old age psychiatry and memory clinics at outpatients' hospitals.

PARTICIPANTS

Hundred and ninety-eight people with MCI or early-stage dementia were included.

INTERVENTION

The intervention group (n = 100) received 11 individual weekly sessions of the CORDIAL program. This intervention includes elements from CBT, cognitive rehabilitation, and reminiscence therapy. The control group (n = 98) received treatment-as-usual.

MEASUREMENTS

We assessed Montgomery-Åsberg Depression Rating Scale (MADRS) (main outcome), Neuropsychiatric Inventory Questionnaire, and Quality of Life in Alzheimer's disease (secondary outcomes) over the course of 4 months and at a 10-month follow-up visit.

RESULTS

A linear mixed model demonstrated that the depressive symptoms assessed by MADRS were significantly more reduced in the intervention groups as compared to the control group (p < 0.001). The effect persisted for 6 months after the intervention. No significant differences between groups were found in neuropsychiatric symptoms or quality of life.

CONCLUSION

Our multicomponent intervention, which comprised 11 individual sessions of CBT, cognitive rehabilitation, and reminiscence therapy, reduced depressive symptoms in people with MCI and dementia.

Fronto-temporal dementia: a case study and strategies and support for caregivers

Fronto-temporal dementia, also known as fronto-temporal lobular degeneration, is the second most common form of early-onset dementia with a prevalence equal to Alzheimer's dementia. Behavioural variant fronto-temporal dementia primarily involves the frontal and temporal lobes of the brain. Myelination of nerve fibres in these areas allow for highly synchronized action potential timing. Diagnosis is often significantly delayed because symptoms are insidious and appear as personality and behavioural changes such as lack of inhibition, apathy, depression, and being socially inappropriate rather than exhibiting marked memory reductions. In this article, a case study illustrates care strategies and family education. Management of severe behavioural symptoms requires careful evaluation and monitoring. Support is especially important and beneficial in the early to middle stages of dementia when nursing home placement may not be required based on the individual's condition.

A systematic review of dyadic approaches to reminiscence and life review among older adults

Objective: This paper describes a systematic review of quantitative and qualitative studies that examine the effectiveness of dyadic approaches to life review and reminiscence. Methods: The search process began with 1,056 potentially eligible articles and, after a multi-step screening process, led to 20 full-text articles for review. Results: The resulting studies (ten quantitative, nine qualitative, and one mixed-method) comprised six different kinds of dyadic approaches. There are a combination of benefits and problems associated with dyadic life review and reminiscence approaches. Conclusions: This review provides initial understanding of the impact of life review and reminiscence when care recipients and caregivers participate in the intervention together. Future clinical studies on dyadic approaches to life review and reminiscence should provide clearer descriptions of their protocols, include more consistent measures (incorporating in-the-moment measures), and involve populations of healthy older adults and their partners as well as those with cognitive impairment. The inclusion of qualitative studies helps interpret the diverse results reported in the quantitative studies and highlights key themes related to participating in dyadic interventions.

Seizure burden in severe early-life epilepsy: Perspectives from parents

OBJECTIVES

Seizure burden is typically measured by seizure frequency yet it entails more than seizure counts, especially for people with severe epilepsies and their caregivers. We aimed to characterize the multi-faceted nature of seizure burden in young people and their parents who are living with severe early-life epilepsies.

METHODS

A one-day workshop and a series of teleconferences were held with parents of children with severe, refractory epilepsy of early-life origin and providers for children with epilepsy. The workshop sessions were structured as focus groups and aimed to identify components of seizure burden and their impact from the perspective of parents and providers. Data were gathered, organized, and refined during the workshop using an iterative 4-step process that drew upon grounded theory.

RESULTS

Three primary components of seizure burden were identified: frequency, severity, and unpredictability, which was as important if not more important at times than frequency and severity. Caregivers noted that the impacts of seizures were experienced as acute-immediate consequences, longer-term consequences, and as chronic effects that develop and evolve over time. The severity of the child's neurological and medical status as well as where in the disease journey a family was represented additional contextual factors that influenced the experience of seizure burden.

SIGNIFICANCE

Patient-reported and patient-centered outcomes are increasingly incorporated into the evaluation of treatment effectiveness. Without understanding how the disease creates burden for the patient (or family), it is difficult to know how to assess the impact of treatment. Our preliminary findings indicate seizure burden is a complex construct and unpredictability can be as important as frequency and severity.

That mr. Alzheimer… you never know what he's up to, but what about me? A discourse analysis of how Swedish spouse caregivers can make their subject positions understandable and meaningful

The spouses of people suffering from dementia are commonly first-in-line caregivers. This can have a considerable effect on their own lives, health and marriages. Several studies have focused on spouses' experiences, but very few have focused in any depth on their descriptions of themselves as subjects. Therefore, the aim of this study is to describe how spouse caregivers can express themselves when living with and caring for their partners with dementia. The study has a qualitative approach with a discourse analysis design and uses analytical tools such as rhetoric, subject positions and categorization. The results reveal three subject positions: as an actor, as a parent and as a survivor. The results show that as spouses struggle with external and internal clashes as subjects, they therefore need to develop coping strategies. They also experience pronounced loneliness and a risk to their own health. There is thus a need to support these spouses as individuals in their differing and changing needs.

Creating a meaningful everyday life: Perceptions of relatives of people with dementia and healthcare professionals in the context of a Danish dementia village

BACKGROUND

The world's aging population contributes to an increase in people living with dementia, which is perceived as one of the main causes of disability and dependency for older people. The first dementia village in Denmark was established in 2015, with the intention of providing a safe and meaningful everyday life for people with dementia. The purpose of the study was to explore the way in which relatives of people with dementia and healthcare professionals create and maintain a meaningful everyday life for the residents in a Danish dementia village.

METHODS

A methodology for user involvement in public service development and evaluation called 'The BIKVA methodology' was used followed by a thematic analysis. A purposive sample of 32 participants took part in the study.

RESULTS

The analysis revealed one main theme, 'Enabling a familiar and meaningful everyday life in the dementia village', with three corresponding subthemes, reflecting the way in which relatives of people with dementia and healthcare professionals create and maintain a meaningful everyday life for the residents in a Danish dementia village.

CONCLUSION

The findings showed that relatives of people with dementia and healthcare professionals were committed to creating and maintaining a meaningful everyday life for the residents, but also revealed different understandings of when, where, and how this could be understood and best be achieved. Furthermore, people with advanced dementia may not be able to benefit from the activities and possibilities provided by the dementia village, since this required resources beyond what could be provided.