Holding on while letting go: trauma and growth on the pathway of dementia care in families

OBJECTIVES

Limited research explores the medical model of residential care in dementia from the family caregiver's perspectives.

METHOD

This study sought subjective interpretations of nine family caregivers who experienced relinquishing their status as primary caregiver to a medical model, dementia care residential setting. Following semi-structured interviews and transcription data was analysed using interpretative phenomenological analysis.

RESULTS

One superordinate theme, navigating 'system' control, overarched three subordinate themes: connecting/disconnecting, windows closing, and capacity for sensation. Navigating system control reflected participants' experience of circumnavigating a medical system fraught with hierarchical challenges inclusive of a complex maze of contradictions that appeared threatening, yet appeared comforting; authoritarian, yet often humane. For them, care of self, while advocating for a family member with dementia, required vigilance to manoeuvre a system of care that imposed its uninvited authority at will. Connection/disconnection highlights the enduring struggle for inclusivity in caregiving despite the omnipresent trauma of windows closing. Psychological growth came to these participants through an unexpected capacity for sensation which offered a unique lens to communication with the family member with dementia primarily through sensory exchange.

CONCLUSIONS

Models of dementia care and therapeutic interventions could inclusively involve dementia family caregivers who may be experiencing traumatic distress, and associated guilt, stigma, loss, and grief. Co-existing psychological wellbeing, however, is possible when family members are encouraged to transition communication to sensory awareness and exchange as windows close.

Shame, hope, intimacy and growth: Dementia distress and growth in families from the perspective of senior aged care professionals

Minimal research explores the impact of dementia and a dementia diagnosis on families from the unique vantage of senior health professionals. The participants of this study, eight senior aged care professionals, provided unique interpretative insights into family dynamics and sense-making on the journey with dementia, and their own role in that journey. Both positive and negative perspectives were sought. Data from semi-structured interviews were analysed using Interpretative Phenomenological Analysis (IPA). One superordinate theme, Dementia naiveté; redefined intimacy, overarched Embarrassed shame; Maintaining hope; Redefining a model of intimacy; and Redefined relational intimacy and growth. Within these themes, the participants shed light on hurtful embarrassment and shame experienced by families associated with the diagnostic label given to a loved one. This label was perceived to either trigger separation, hurt and immobility through ignorance, or precipitate a frenzy of naive yet hopeful energy for seeking that elusive cure. The participants saw their role as one of enacting a new way of connecting what was with what could be. Thus, they modelled advocacy, integral care and relational intimacy. Validation came in witnessing a redefining of intimacy in many families who were able to embrace that holistic and empathic approach to the shifting presentation of dementia. Psychological well-being was observed to occur when families embraced growthful domains, e.g. acceptance, hope, relational closeness and altruistic concern for other families. Implications for future care models are discussed.

Cancer-related trauma, stigma and growth: the 'lived' experience of head and neck cancer

Head and neck cancer is associated with multiple layers of distress including stigma. Stigma attraction or devalued social identity is twofold: (1) it is a cancer associated with lifestyle risk factors and (2) treatment often results in confronting facial disfigurement. Subjective interpretations from nine head and neck cancer patients were analysed using Interpretative Phenomenological Analysis. An overarching superordinate theme--Distress, Stigma and Psychological Growth--encompassed four subordinate themes. Two themes captured the expressed trauma and terror as a result of diagnosis and treatment, and two the redefining of self despite stigma through meaning making. Distress was interpreted as a catalyst for awakening new life interpretations and combined with social support to facilitate two distinct pathways of growth: (1) psychological growth without support; (2) psychological and relational growth with support. Previously unfelt empathetic understanding and altruism for others with cancer emerged from the impact of stigma on 'self'. Acceptance allowed a new sense of identity that recognised cancer-related traumatic distress as integral to growth for these participants. The present study offers a unique insight into cancer-related trauma and stigma and the potential to redefine a more accepting, empathic and altruistic 'self' for psychological growth. Implications are discussed.

Suicidal ideation and mental distress among adults with military service history: results from 5 U.S. states, 2010

OBJECTIVES

We examined the association of military service history with past-year suicidal ideation and past-30-days mental distress in a probability-based sample of adults.

METHODS

We gathered 2010 Behavioral Risk Factor Surveillance System data from 5 states that asked about past-year suicidal ideation. Military service was defined as current or former active-duty service or National Guard or Reserves service. We stratified analyses into 18 to 39 years, 40 to 64 years, and 65 years and older age groups and used multiple logistic regression analyses, adjusted for demographic confounders, to discern the association of military service history with past-year suicidal ideation and past-30-days mental distress.

RESULTS

Among the 26,736 respondents, 13.1% indicated military service history. After adjusting for several confounders, we found military history status among those aged 40 to 64 years was associated with both past-year suicidal ideation and past-30-days mental distress. We found no significant associations among the younger or older age groups.

CONCLUSIONS

Differences in suicidal ideation between military and nonmilitary individuals may occur in midlife. Future research should examine the possibility of cohort effects, service era effects, or both.