Sources and perceptions of hope: A qualitative study involving younger people with dementia

Hope is an important but overlooked phenomenon in dementia studies. Few studies have examined how people with dementia experience or perceive hope, possibly because it is seen as a diagnosis without hope. In this article, we report on a doctoral study, the aim of which was to examine the phenomenon of hope from the perspective of younger people with dementia to generate new understanding and enable community-based healthcare professionals to support well-being. The study was conducted in the Midlands, England, and used a modified diary-interview method. Six participants were given a camera and asked to take pictures of whatever made them feel hopeful. During a post-diary semi-structured interview, a conversation about hope took place. Interviews were transcribed and interpreted using the 'Voice-Centred Relational Method'. Findings show that hope is important to younger people with dementia. Sources of hope were the surrounding environment, keeping connected, taking action, and drawing on internal resources. An over-arching theme was 'defying dementia' and participants demonstrated resistance to negative stereotypes. Living with dementia did not curtail hope, although it could be weakened when participants felt 'cast adrift' by services. The In vivo codes generated were fear of dementia, threats to identity, disconnection from others, and frustrations and restrictions. It is concluded that hope should be a more central part of practice-based conversations with people with dementia.

Predictors and Moderators of Quality of Life in Alzheimer's Disease Patients

BACKGROUND

Alzheimer's disease (AD) is a chronic degenerative disease leading to global cognitive and functional decline. Quality of Life (QOL) is an important variable in the effectiveness of intervention programs in dementia.

OBJECTIVE

This study analyzed the relationships between gender, psychological variables and QOL, the predictors of QOL, and the role of spirituality as a moderator between functionality and QOL.

METHOD

A cross-sectional study was conducted with 128 patients with mild AD.

RESULTS

Being a male, good social support, and high functionality were significant predictors of better QOL. Spirituality was a moderator in the relationship between functionality and QOL.

CONCLUSION

These results reinforce the importance of gender, psychological morbidity, social support, and functionality, with special emphasis on the role of spirituality, regarding intervention programs that promote QOL, in patients with mild AD.

Validation of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp12) on French Old People

The study aimed to develop a French version of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being short version (FACIT-Sp12), in order to provide a self-reported measure for French people in the field of gerontology. The study involving 63 nursing home residents was conducted to evaluate the construct validity, reliability, and convergence validity of the FACIT-Sp12. A confirmatory factor analysis corroborated a three-factor model (Meaning, Peace and Faith) with modifications for two items, also valid among people with cognitive impairment. Subscales showed good internal consistency and are correlated with quality of life and depression. In conclusion, the validated French version is an suitable instrument to study the maintenance and promotion of quality of life in the elderly.

The experience of spirituality from the perspective of people living with dementia: A systematic review and meta-synthesis

Spirituality is an important aspect of humanity. Concerned with deriving meaning from events, and connection with others, it provides a mechanism for some to cope with illness and disability. While spiritual support is recognised as important, little is known about the spiritual needs of those people experiencing dementia. This meta-synthesis considers the experiences of spirituality from the perspective of people living with a diagnosis of dementia. Using a review protocol, key words from a preliminary scoping review were used to direct database searches in November 2013. A total of 667 papers were initially identified. However, following careful quality review assessment a final eight papers were selected. Findings demonstrated the ongoing importance of spirituality to people living with dementia and its importance as a means of finding hope, meaning and linkage with past, present and future. Expression of spirituality through faith practices, contact with faith communities, and the impact of dementia on these, were also highlighted.

Quality of life in dementia in perspective

Many different definitions of the concept of quality of life (QOL) are found in the literature. This raises the question as to which domains are viewed as really important by people with dementia and which are possibly based on views of others, such as (in)formal carers, or theoretical models. An explorative study was carried out among people with dementia living in the community and in nursing homes. Their opinions were compared to those of professional carers and to the current theoretical models and instruments for QOL in dementia. Data were gathered by means of interviews, focus groups and literature study. Most QOL domains mentioned as important by the persons with dementia were also acknowledged by the carers and in the literature. A few, however, were not mentioned by the carers (i.e. ‘sense of aesthetics in living environment’,‘financial situation’ and ‘being of use/giving meaning to life’), and not selected in the measuring instruments (‘security and privacy’, and ‘self-determination and freedom’). This indicates differences in perspectives on quality of life between persons with dementia, their carers and theoretical models. Further research is recommended on this point.

The effect of multi-sensory ministry on the affect and engagement of women with dementia

Individuals with dementia find it difficult to cognitively follow oral presentations of intangible concepts that are part of most traditional worship experiences. Although anecdotal reports of non-cognitive methods of ministry are found in the literature, alternative forms of worship for people who have dementia have seldom been systematically studied. This research compared the effects of two multi-sensory methods of ministry with a traditional ministry method on the affect and engagement of women with dementia. Twenty-four participants were each presented three forms of worship. Trained observers recorded the number of seconds of observable pleasure (affect) and alertness (engagement) during 10-minute presentations. There was a difference at the .05 confidence level between the traditional ministry visit and the two multi-sensory methods of ministry on measures of pleasure and alertness. No effect for either presentation order or observer was found. Multi-sensory tools had a positive influence on the observable experience of participants in this study.

A literature review of spirituality in coping with early-stage Alzheimer's disease

AIMS

This paper presents a literature review focusing on the use of spirituality in coping by older persons with early-stage Alzheimer's disease from their perspectives. The purpose of this literature review is to examine the existing body of knowledge about spirituality in coping with Alzheimer's disease and to apply a spiritual framework of coping in organizing the literature to identify themes and gaps in knowledge.

BACKGROUND

Despite the abundance of Alzheimer's disease research, little is known about how older persons with this devastating disease cope with the consequential losses. Maintaining a sense of normalcy and preserving self-worth are coping strategies reported by older persons with early-stage Alzheimer's disease. As spirituality is an effective coping resource for older persons with numerous psychological and personal losses in their lives, it may be an important coping resource for person with Alzheimer's disease.

METHOD

A literature search was conducted to find research published between 1990-2006 aimed at understanding spirituality in coping with early-stage Alzheimer's disease.

CONCLUSIONS

Six research studies were reviewed. Findings suggest that persons with early-stage Alzheimer's disease draw from their spirituality and faith to find meaning and courage in facing the challenges of cognitive losses. Furthermore, they are able to provide rich information about their spirituality and the psychosocial aspects of living with Alzheimer's disease. Limited empirical knowledge compels the need for future research to explore how spirituality is utilized in coping with early-stage Alzheimer's disease.

RELEVANCE TO CLINICAL PRACTICE

Enhancing persons' abilities to cope effectively with their diseases is an important goal of nursing care. Understanding how older persons with Alzheimer's disease cope with their memory loss is critical to the development of evidence-based interventions to minimize the stress of living with this disease.

Religiosity and quality of life: a dyadic perspective of individuals with dementia and their caregivers

OBJECTIVES

Dyadic coping theory purports the benefit of joint coping strategies within a couple, or dyad, when one dyad member is faced with illness or stress. We examine the effect of religiosity on well-being for individuals with dementia (IWDs). In particular, we look at the effect of both dyad members' religiosity on perceptions of IWDs' quality of life (QoL). Neither of these issues has been extensively explored.

METHOD

One hundred eleven individuals with mild-to-moderate dementia and their family caregivers were interviewed to evaluate IWDs' everyday-care values and preferences, including religious preferences. Using an actor-partner multi-level model to account for the interdependent relationship of dyads, we examined how IWD and caregiver ratings of religiosity (attendance, prayer, and subjective ratings of religiosity) influence perceptions of IWDs' QoL.

RESULTS

After accounting for care-related stress, one's own religiosity is not significantly related to IWDs' or caregivers' perceptions of IWD QoL. However, when modeling both actor and partner effects of religiosity on perceptions of IWDs' QoL, caregivers' religiosity is positively related to IWDs' self-reports of QoL, and IWDs' religiosity is negatively associated with caregivers' perceptions of IWDs' QoL.

CONCLUSION

These findings suggest that religiosity of both the caregiver and the IWD affect perception of the IWD's QoL. It is important that caregivers understand IWDs' values concerning religion as it may serve as a coping mechanism for dealing with dementia.

Spirituality and religion in older adults with dementia: a systematic review

BACKGROUND

Religious and spiritual issues are clearly important to the older adult population and may play a positive role in maintaining health and recovering from illness. This study systematically reviewed the literature examining the effects of religion and spirituality on health outcomes such as cognitive functioning, coping strategies, and quality of life in people with dementia.

METHODS

First, 51 articles with defined keywords were collected from online databases. Then, using inclusion and exclusion criteria, 11 articles were selected. These were classified according to methodological quality before being analyzed one by one.

RESULTS

The findings highlight the benefits of spirituality and religion on health outcomes. Three articles showed that in participants who used their spirituality or religion more, through their faith, their practices and in maintaining social interactions, their cognitive disorders tended to reduce or stabilize. In the other eight articles, use of spirituality or faith in daily life enabled people to develop coping strategies to help accept their disease, maintain their relationships, maintain hope, and find meaning in their lives, thereby improving their quality of life.

CONCLUSIONS

Spirituality and religion appear to slow cognitive decline, and help people use coping strategies to deal their disease and have a better quality of life. This literature review allows us to take stock of research over the last decade on spirituality/religion and health outcomes. The benefits observed should be considered with caution and included in rigorous experimental research in the future.

Living with a diagnosis of behavioural-variant frontotemporal dementia: The person's experience

Research investigating behavioural-variant frontotemporal dementia has concentrated on identifying and quantifying people's difficulties; yet few studies have considered how people with behavioural-variant frontotemporal dementia make sense of their difficulties. Five participants were interviewed and interpretive phenomenological analysis used to analyse the data. Two superordinate themes emerged: 'Bewilderment' and 'Relationships with others'. 'Bewilderment' reflected the feelings of the participants from the start of their dementia, and was divided into two main themes (1) 'Awareness of change: What's the problem? and (2) Threats to self: This is not me. The superordinate theme, 'Relationships with others', reflected difficulties with social relationships and comprised two main themes (1) 'Family and friends: Things haven't changed… but do I say anything wrong?' and (2) Coping with threats to self: Blame others or just avoid them. The themes were discussed in relation to literature evaluating the difficulties associated with behavioural-variant frontotemporal dementia together with implications for clinical practice.

The lived experience of spirituality and dementia in older people living with mild to moderate dementia

A literature review highlighted the importance of understanding the subjective experience of spirituality and dementia. Two research aims were identified: to build an understanding of how older people's experience of spirituality, religion or faith is affected by having dementia and to understand how the spiritual aspects of their lives affect the experience of dementia. Six older people with mild to moderate dementia were interviewed about their experience of spirituality and dementia. Interview transcripts were analysed using Interpretive Phenomenological Analysis. Five superordinate themes were identified: experience of faith; searching for meaning in dementia; ‘I'm not as I was’ – changes and losses in experience of the self; staying intact; and current pathways to spiritual connection and expression. The results offered a unique perspective on the experience of spirituality and dementia, uniting themes from both research and theory concerning the experience of the self and the experience of spirituality in dementia.

Spiritual nurturance and support for nursing home residents with dementia

This mixed method study examined nursing home resident, family and staff views regarding spiritual nurturance and support for persons with dementia and analyzed institutional resources/approaches for meeting residents’ spiritual needs. For residents able to communicate in words (n = 47/83 or 57%), this topic evoked a range of emotional content, brought back memories, and yielded information about what mattered to them spiritually/religiously. Some observations and reported behaviors of residents unable to be interviewed directly (n = 36/83 or 43%) suggested emotional awareness of spiritual activities. Family member/staff perspectives revealed beliefs, concerns, and needs for support/training in the provision of spiritual care. Quantitative findings were consistent and identified differences between surveyed nursing homes (n = 48) with and without religious affiliations. Discussion of personhood, spiritual/ religious coping, and meeting spiritual care needs led to conclusions about the role of professional chaplaincy in educating and modeling for staff and others appropriate behaviors for providing spiritual support as well as the importance of accommodating diversity and maximizing resources.

Remaining hopeful in early-stage dementia: a qualitative study

OBJECTIVES

Improving the quality of life for people living with dementia is widely accepted as an important outcome in dementia care services. Positive psychology, the systematic study of strengths, capacities, and personal resources, is one framework for understanding how a person with dementia might achieve this. This study investigated the subjective experience of hope-a construct from the discipline of positive psychology in older people with early-stage dementia.

METHOD

Ten volunteer participants over the age of 65 years were recruited from a memory clinic in England. Semi-structured interviews were used to explore participants' hopes, in terms of their personal meaning, their resources, and the potential barriers and facilitators of hope in dementia. Interviews were analyzed using interpretative phenomenological analysis (IPA).

RESULTS

Eight themes were extracted, subsumed under two higher-order themes: 'live in hope or die in despair' and 'keep living and keep living well'. Participants described how their internalized hope-fostering beliefs that were often learned during childhood were challenged by the reality of hope-hindering experiences associated with old age and dementia. A balancing process of re-appraisal enhanced resolution and this sense of stability then allowed them to develop positive attitudes towards common age-related constraints in their health and social circumstances.

CONCLUSION

The findings offer insight into the existence, nature, and relevance of hope in the lives of people with early-stage dementia. They provide a useful framework for developing hope-fostering strategies in early interventions that aim to assist individuals with dementia to maintain their quality of life.

Using spirituality to cope with early-stage Alzheimer's disease

Alzheimer's disease (AD) robs persons living with the disease of their independence and self-esteem, which can lead to depression, anxiety, and loneliness. Understanding how people with early-stage AD cope is a critical step in enhancing their adaptive abilities and ultimately improving their quality of life. This qualitative study describes how individuals with early-stage AD use spirituality to cope with the losses of self-esteem, independence, and social interaction that they face. The purposive sample for this focused ethnographic study consisted of 15 participants living at home in central Arkansas. Holding onto faith, seeking reassurance and hope, and staying connected were the global themes. Personal faith, prayer, connection to church, and family support enhanced the ability of people with early-stage AD to keep a positive attitude as they face living with AD.

The evaluation of spiritual care in a dementia care setting

Spiritual care has become an integral part of the care package offered to older people who move to residential care. However, spirituality is a word that can mean everything or nothing and as such becomes difficult to define. Assessment of `spiritual care' becomes a real challenge, because it raises important questions. These are as follows: the nature of spiritual care; how it is offered; and who takes responsibility for it. This is especially true in dementia care homes where residents cannot normally take part in evaluation. This paper offers a model of evaluation of spiritual care by using reflection, relationship and restoration, and through observing the virtues described in the Biblical concept of `fruit of the spirit'.