Personhood in dementia care

Competency development for a volunteer navigation program to support caregivers of people living with dementia: A modified e-Delphi method

Caregivers of people living with dementia are pillars of the care community. Providing them with adequate support throughout their caregiving journey is essential to their quality of life and may also contribute to improving the care of people living with dementia. Nav-CARE (Navigation - Connecting, Advocating, Resourcing, Engaging) is a volunteer-led navigation program that provides support to older adults with life-limiting illnesses who are living in the community. However, Nav-CARE does not provide support directly to caregivers of people living with dementia. To adapt Nav-CARE to support caregivers, we needed to establish caregivers' needs and the competencies volunteer navigators should be trained in to support caregivers to meet these needs. To do so, a modified e-Delphi method was utilized, which consisted of administering three sequential questionnaires to a panel of 35 individuals with expertise in a variety of dementia related domains. Through this, two final lists of 46 caregivers' needs and 41 volunteer competencies were established to inform the development of volunteer navigator training curriculum. Findings suggest that trained volunteer navigators may be able to support caregivers of people living with dementia throughout the disease trajectory and can be used to inform the development of future dementia navigation programs.

Entre ilhas fabulosas: etnografia, autismo e demência em relação

Resumo A partir de um conjunto heterogêneo de materiais (relatos autobiográficos, textos e reflexões produzidas por autistas e pessoas com demência, cenas e conversas em pesquisa de campo, imagens), este artigo mapeia relações entre formas expressivas dos modos de ver, mostrar e escrever processos neurológicos-mentais-cognitivos demenciais e neurodivergentes enquanto experiências que abrem possibilidades para pensar linguagem, pessoa, corpo, mente, mundo. Os materiais que transitam do pré-verbal ao verbal evidenciam tensões do fazer e da escrita etnográficos. Falas truncadas, palavras embaralhadas, desaparecidas, palavras-imagens, movimentos corporais em silêncio trazem desafios metodológicos, epistemológicos, ontológicos e éticos. Destacamos momentos que autistas e pessoas com demência nos falam de um mundo-outro e exploramos conceitualmente a experiência do entre para ficarmos no “limiar do entendimento”, traçar “linhas de fuga” ou “de errância” e aí transbordar o autismo e a demência da biomedicina para outras direções: da patologia ao páthos, do sintoma à experiência e a outro mundo possível.

Well-Being Benefits of Horticulture-Based Activities for Community Dwelling People with Dementia: A Systematic Review

Most people living with dementia in the early-to-middle stages live in the community or in their own homes and engagement in enjoyable activities is fundamental to maintaining quality of life and autonomy. Horticulture-based activities are beneficial for the health and well-being for people living with dementia ("PLWD") in residential care settings, yet evidence within community settings, where the majority live, has not been comprehensively synthesized. A mixed studies systematic review protocol was registered and a systematic search conducted to June 2022 across MEDLINE, COCHRANE, Web of Science, Embase, Psycnet, CINAHL, PsycINFO databases, using terms relating to dementia and horticulture. Original studies examining group or individual horticulture-based programs for community-dwelling PLWD were included. Forty-five articles were selected for full review, eight met inclusion criteria and were retained for data extraction. Evidence from three mixed methods, two quantitative, two qualitative, and one case study design, involving a total of 178 community dwelling PLWD, was narratively summarized. Findings revealed that involvement in horticulture-based activities led to positive impacts on engagement, social interactions, and mental and physical well-being in PLWD. No conclusive evidence was found from included studies for improvement in cognitive function. As most studies to date have concentrated on PLWD in long-term care settings, future research should evaluate the effect of these types of activities in a more rigorous intervention design in community settings.

The use of visual methods to support communication with older adults with cognitive impairment: A scoping review

Older adults with cognitive impairment often face difficulties with comprehension and communication, which can impact other cognitive processes such as decision-making. This scoping review investigates how visual methods can support older adults with cognitive impairment. The review involved querying four databases. From these databases, eleven articles fit inclusion criteria. This paper examines the purposes, use contexts, types, and effectiveness of the visual methods described in each study. The two major use contexts were elicitation of thoughts, feelings, and preferences in everyday life and health/healthcare related uses. Studies that used visual methods for eliciting preferences generally employed static visualizations. Health-related contexts employed more complex and interactive visualizations. Three studies used visual tools to support older adults in understanding; six, communication; and three, decision-making. None addressed all three outcomes of interest. This study provides recommendations and future directions for visual communication research with older adults with cognitive impairment.

Rethinking the Precedent Autonomy, Current Minimal Autonomy, and Current Well-Being in Medical Decisions for Persons with Dementia

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.

Interdisciplinary Research: An Important Contribution to Dementia Care

Authorities and research institutions emphasise and encourage interdisciplinary research to meet complex societal health challenges as dementia. However, studies that describe an interdisciplinary approach for dementia research are limited. What does it take for research to become interdisciplinary? Is it enough to include researchers from different disciplines? This paper reflects on an interdisciplinary approach to dementia research. Based on existing literature and theories, we elaborate the concept of interdisciplinarity, and how the perspective can contribute and improve dementia care.

"When I hear my language, I travel back in time and I feel at home": Intersections of culture with social inclusion and exclusion of persons with dementia and their caregivers

Individuals with dementia and their carers often experience a rupture of relationships that co-occurs with declining functional and cognitive abilities, leading to their increased social exclusion in both intimate relationships and community settings. While initiatives have been developed to support meaningful interaction and participation in society, they have broadly ignored the significance of how cultural factors influence experiences of inclusion/exclusion of these individuals. An ethnographic study was conducted by an interdisciplinary research team between April 2018 and January 2019 to explore the intersections of culture and social inclusion/exclusion in a culturally diverse group of persons with dementia, caregivers and staff members of a non-profit organization located in a multicultural neighborhood of a bilingual Canadian city. The participants' culture was inextricably linked to their experiences in three overarching themes of social inclusion/exclusion: transformation of the person with dementia and the caregiver; participation in social networks and meaningful relations; and styles of care provision in health and social services. Cultural mandates that prescribe practices of intergenerational care shape the way certain caregivers perceive their role and mitigated experiences of exclusion. Culturally specific notions and views associated with dementia prevalent in certain communities increased experiences of inclusion or exclusion. Engagement with the cultural elements of individuals with dementia was shown to be an effective and underexplored tool for fostering inclusion. The results of this study highlight the value of the ethnographic methods for incorporating the perspective of persons with dementia in research.

Improving nursing students' perspective taking, perceptions of humanness, and attitudes toward older adults

Whereas prior work has examined the role of nursing courses in improving empathic skills and reducing dehumanization of older adults, little research has explored how perspective taking and perceptions of humanness of older adults acquired through nursing curricula predict attitudes toward this age group. Nursing students (N = 43) completed surveys at the beginning (Time 1) and end of gerontological coursework (Time 2). Perspective taking and perceived human nature and human uniqueness of older adults increased from Time 1 to Time 2. Perceived human nature of older adults was associated with more positive attitudes at the end of the semester, compared to the beginning. Improved perceptions of the human nature of older adults also predicted lower ageism at the end of the semester. Strategies for improving perspective taking and perceptions of humanness of older adults in nursing courses are discussed.

Die Angst vor dem Sinnverlust nach der Diagnose Demenz. Eine Rekonstruktion unter Bezug auf Susan Wolf

Verbunden mit dem drohenden Verlust von kognitiven Kapazitäten und der Veränderung der eigenen Persönlichkeit, ist zu vermuten, dass bei Demenzerkrankungen ein Sinnverlust vom Erkrankten befürchtet wird. Es ist Aufgabe dieses Papers aufzuklären, was es mit einer solch meist diffus empfundenen Angst auf sich hat. Dazu wird ein Deutungsangebot gemacht, das auf die Sinnkonzeption Susan Wolfs zurückgreift. Es wird gezeigt, dass es möglich ist, bis zu einem gewissen Grad der Demenz ein sinnvolles Leben zu führen – ein Leben, bei dem subjektiv Anziehendes und rational (bzw. objektiv) Wertvolles zusammengreifen müssen. Dies ist möglich, weil ein Mensch mit Demenz noch über entsprechende Fähigkeiten der Wertschätzung verfügt und eine Hilfsbedürftigkeit der Befähigung zu einem sinnvollen Leben nicht widerspricht. Bei einer sehr schweren Beeinträchtigung der kognitiven Kapazitäten wird es hingegen nicht mehr möglich sein, ein solches Leben zu leben; die solcherart erkrankte Person wird dies aber auch nicht mehr vermissen. Wenn das, was man mit der Demenzerkrankung zu verlieren befürchtet, durch das Sinnverständnis Wolfs getroffen ist, dann sollte man diese Überlegungen bei der Beurteilung einer empfundenen Angst berücksichtigen.

Continuing to Participate in the Dance of Life as Oneself: The Lived Experience of Meaning in Life for Older Adults With Alzheimer's Disease

BACKGROUND AND OBJECTIVES

Meaning in life is an important aspect of positive psychological functioning for older adults. Limited work suggests the relevance of the experience of meaning for people with dementia, but research into this experience from their personal perspective is lacking. The current study provides an in-depth investigation of the lived experience of meaning in life for older adults with Alzheimer's disease.

RESEARCH DESIGN AND METHODS

The study was conducted following the phenomenological reflective lifeworld approach. In-depth interviews were conducted with 16 older adults (+65) with Alzheimer's disease living either at home or in a nursing home in Belgium. Data analysis was an iterative process aimed at illuminating the constituents and essence of the phenomenon.

RESULTS

The essence of the experience of meaning in life for participants was understood as "continuing to participate in the dance of life as oneself." This experience was further clarified in four closely intertwined constituents: (a) feeling connected and involved, (b) continuing everyday life as oneself, (c) calmly surrendering and letting go, and (d) desiring freedom, growth, and invigoration.

DISCUSSION AND IMPLICATIONS

Our findings contribute to a deeper understanding of meaning in life as experienced by older adults with Alzheimer's disease themselves. They emphasize the relevance of the concept for psychological dementia research and offer original insight for the inclusion of meaning in life as an important aspect of holistic dementia care.

Resource allocation across the dementia continuum: a mixed methods study examining decision making on optimal dementia care among health and social care professionals

Background

The understanding of appropriate or optimal care is particularly important for dementia, characterised by multiple, long-term, changing needs and the increasing expectations of people using services. However, the response of health and social care services is limited by resource constraints in most countries. This study sought to determine the optimal level, mix and cost of services for different dementia case types across the dementia continuum, and to better understand the resource allocation decision making process among health and social care professionals (HSCPs).

Methods

A balance of care framework was applied to the study questions and developed in three ways; firstly by considering optimality across the course of dementia and not just at the margin with residential care; secondly, through the introduction of a fixed budget to reveal constrained optimisation strategies; and thirdly through the use of a mixed methods design whereby qualitative data was collected at workshops using nominal group technique and analysed to obtain a more detailed understanding of the decision-making process. Twenty four HSCPs from a variety of disciplines participated in the resource allocation decision-making exercise.

Results

HSCPs differentiated between case type severity; providing 2.6 times more resources to case types with higher level needs than those with lower level needs. When a resource constraint was introduced there was no evidence of any disproportionate rationing of services on the basis of need, i.e. more severe case types were not favoured over less severe case types. However, the fiscal constraint led to a much greater focus on meeting physical and clinical dependency needs through conventional social care provision. There was less emphasis on day care and psychosocial provision when resources were scarcer following the introduction of a fixed budget constraint.

Conclusions

HSCPs completed complex resource allocation exercises for people with dementia, including expected differentiation across case type severity. When rationing was introduced, HSCPs did not discriminate in favour of case types with high levels of need. They did, however, support conventional home care provision over psychosocial care, although participants were still keen to provide some residual cover for the latter, especially for case types that might benefit.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06230-9.

Couplehood as a compass: Spousal perspectives on the diminished everyday competence of partners

Research on spousal relations and caregiving, when one of the persons in the dyad has a dementia diagnosis, has recognized that the degree of diminished everyday competence (DEC) the person with dementia is experiencing has implications for these relations and for how spousal caregiving is ultimately experienced. The present exploratory study uses an inductive approach to analyze data from 22 qualitative interviews with and observation notes on couples living with dementia to shed light on the ways in which the person without dementia views the DEC his/her partner is experiencing. The findings show that spouses can choose to disregard their partners' DEC or to acknowledge it in either an egocentric or a couple-centered way; they also show that spouses' choice of approach does not seem to be dictated by how cognitively impaired their partners have become. This suggests that spouses' approach to partners' DEC deserves more of our attention as it could have implications not only for transitions into spousal caregiving but also for caregiving experiences as such.

A multiple perspective view of personhood in dementia

Personhood has been a key influence on the development of person-centred care models in dementia. However, there is ambiguity around the concept and interpretation of personhood, and what it means in practical terms for the delivery of care to people with dementia. This study examines the conceptualisation of personhood within the formal care system for people with dementia in Ireland. A multiple perspective study design examines the experiences of personhood in dementia from the perspectives of people with dementia, family carers and a range of formal carers. Semi-structured interviews with participants were conducted in both community and long-term care settings. Interpretative phenomenological analysis is used to examine the data. A total of 31 participants were interviewed: eight people with dementia, eight family carers and 15 formal carers. There is general consensus on the core elements of personhood among all participants: interests and preferences; lifecourse experiences; social interaction; family; and place. However, there is ambiguity among family carers and formal carers in the interpretation of changes to personhood as the disease progresses. Interpersonal and structural barriers to supporting personhood are identified by all participants. The findings provide guidance on the traits of personhood-enhancing care, including effective communication skills, and the potential of health and social care reform to support the core elements of personhood among people with dementia.

Satisfaction with Health Care Interventions among Community Dwelling People with Cognitive Disorders and Their Informal Caregivers-A Systematic Review

Informal caregivers have a leading role when implementing health care services for people with cognitive disorders living at home. This study aims to examine the current evidence for interventions with dual satisfaction with health care services for people with cognitive disorders and their caregivers. Original papers with quantitative and mixed method designs were extracted from two databases, covering years 2009-2018. Thirty-five original papers reported on satisfaction with health care services. The International Classification of Health Interventions (ICHI) was used to classify the interventions. Most interventions had a home-based approach (80%). Reduction in caregiver depression was the outcome measure with the highest level of satisfaction. Interventions to reduce depression or increase cognitive performance in persons with cognitive disorders gave the least satisfaction. Satisfaction of both caregivers and persons with cognitive disorders increased their use of services. In the ICHI, nearly 50% of the interventions were classified as activities and participation. A limited number of interventions have a positive effect on satisfaction of both the persons with cognitive disorders and the caregiver. It is important to focus on interventions that will benefit both simultaneously. More research is needed with a clear definition of satisfaction and the use of the ICHI guidelines.

How Can Autonomy Be Maintained and Informal Care Improved for People With Dementia Living in Residential Care Facilities: A Systematic Literature Review

Background and Objectives

For people with dementia living in residential care facilities, maintaining autonomy and receiving informal care are important. The objective of this review is to understand how caregiving approaches and physical environment, including technologies contribute to the maintenance of autonomy and informal care provision for this population.

Research Design and Methods

A literature review of peer-reviewed articles published between January 1995 and July 2017 was performed. Realist logic of analysis was used, involving context, mechanism and outcome configurations.

Results

Forty-nine articles were included. The improvement of the relationship between residents and formal/informal caregivers is important. This increases the knowledge (sharing) about the resident and contributes to their autonomy. A social, flexible, and welcoming attitude of the formal caregiver improves the provision of informal care. Specially designed spaces, for instance, therapeutic gardens, create activities for residents that remind them of themselves and contribute to their autonomy. Use of technologies reduces caregiver’s time for primary tasks and therefore enables secondary tasks such as interaction with the residents.

Discussion and Implications

The results revealed how residential care facilities could maintain autonomy of their residents and improve informal care delivery using caregiving approaches and the physical environment including technologies. The results are supporting toward each other in maintaining autonomy and also helped in enhancing informal care provision. For residential care facilities that want to maintain the autonomy of their residents and improve informal care delivery, it is important to pay attention to all aspects of living in a residential care facility.

Prioritäten der Pflegeforschung für das Themenfeld "Dementia Care" im deutschsprachigen Raum - Eine Delphi-Studie

Priorities of nursing research in dementia care in German-speaking countries - A Delphi study Abstract. Background and objective: To meet the central needs of people with dementia, their relatives and their caregivers in complex living conditions and care situations, a substantive examination of research priorities is required. The aim of this work was the identification and prioritisation of nursing research topics concerning dementia care in German-speaking countries.

METHODS

To identify existing research agendas in dementia care, we conducted a systematic literature research. As part of a Delphi process, systematically identified dementia care experts from German-speaking countries supplemented research priorities extracted from existing research agendas and assessed their importance. Subsequently, they prioritized topics of particular importance for nursing research.

RESULTS

Fifteen experts supplemented 61 topics previously identified in existing research agendas. They assessed 107 topics in terms of their importance and prioritized 79 topics.

CONCLUSIONS

The research priorities developed are a potential framework for nursing science, health policy and research funding in order to structure research activities. To ensure currency, priorities should be regularly updated and re-opened for discussion.

Availability and utilization of support services for South African male caregivers of people with Alzheimer’s disease in low-income communities

The purpose of this study was to explore the needs of male caregivers of people with Alzheimer’s disease, by ascertaining the availability and utilization of Alzheimer’s disease-related resources in low-income communities in the Western Cape. Semi-structured interviews were conducted with 11 adult males who were familial caregivers of persons with Alzheimer’s disease. They were recruited via purposeful sampling methods. Thematic analysis of the data generated four major themes, namely Awareness, Knowledge and Education; Caregivers who do not use services; Caregivers who use services and Service needs identified by male caregivers. Predominant findings were that male caregivers in lower income communities do not make use of formal Alzheimer’s disease-related services – albeit being aware of them – because they do not perceive a need for its utilization. Instead, male caregivers prefer assistance in the form of respite care in the home environment to relieve and assist them with household needs. The role of culture may have a substantial influence on these patterns of help-seeking behavior due to the emphasis on a collective approach to caregiving using wider, informal social networks. Needs that were identified by the male caregivers in this study included the general awareness of Alzheimer’s disease, access to information regarding service provision, psychoeducation and affordable services within improved care facilities for low-income communities. The findings of this study suggest a starting point for the needs that should be prioritized to facilitate culturally appropriate service use amongst male caregivers in similar settings.

Clinician Word Use in Dementia Evaluation Reports as a Function of Cognitive Impairment

Objectives: To examine the extent to which levels of cognitive status influence patterns of word use in dementia evaluation reports. Methods: We utilized neuropsychological evaluation reports from 61 geriatric primary care patients referred for suspected dementia. Linguistic Inquiry Word Count analysis was utilized to examine clinician language use in patient reports and whether language use differs dependent on the diagnosis rendered. ANOVA analyses were used to analyze group differences in LIWC word counts across clinical indices of cognitive functioning: dementia diagnosis. Results: Our analysis revealed significant differences in language use across diagnostic categories. ANOVA analyses yielded differences in broad negative emotion, F(2,58) = 4.010, p = .023 as well as other subgroups; anxiety-related word groups, F(2,58) = 4.706, p = .013; insight words, F(2,58) = 3.815, p = .028; causation words, F(2,58) = 3.497, p = .037; certainty words, F(2,58) = 6.581, p = .003; negation words, F(2,58) = 3.165, p = .05; time-related words; F(2, 58) = 7.521, p < .001; and human-related words, F(2,58) = 6.512, p = .003. Conclusion: The differences in clinician language use across different diagnostic groups may be reflections of implicit emotional reactions. Many of the patterns found in this study can be linked to previous research concerning word use and underlying thought processes. Clinical Implications: Awareness of language use is helpful in clinical relationships to attenuate stigma and facilitate treatment and research.

Doença de Alzheimer e xamanismo: diálogos (im)possíveis

Resumo Relacionar os processos demenciais ao tornar-se louco ou ser outra pessoa, estar possuído, foi algo que encontrei em cenas e relatos de meu material de campo. É numa tentativa de compreender o que está em jogo nesse “devir outro” que faço um diálogo entre doença de Alzheimer e xamanismo enquanto fenômenos que lidam com processos de transformação em situações-limite, como doença, infortúnio, desordem, morte. Tal diálogo, que percorre aproximações e distanciamentos, permite pensar nos deslocamentos das noções de pessoa, doença e realidade entre os diferentes sujeitos e campos. Ao trazer a discussão sobre xamanismo como um valor de contraste, uma analogia “boa pra pensar”, busquei outras referências para a compreensão da doença de Alzheimer não só como diagnóstico, mas também como experiência, modo de vida - um “mundo outro” - , mostrando como o discurso biomédico da “dissolução de self” se fundamenta em uma noção específica de pessoa.

Health Outcome Prioritization in Alzheimer's Disease: Understanding the Ethical Landscape

BACKGROUND

Dementia has been described as the greatest global health challenge in the 21st Century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, and political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritizing outcomes; and when individual preferences are sought.

OBJECTIVE

Health outcome prioritization is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyze the complex ethical landscape in which this takes place in the most common dementia, Alzheimer's disease.

METHODS

Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematized, and discussed key issues of ethical salience.

RESULTS

Eight areas of ethical salience for outcome prioritization emerged: 1) Public health and distributive justice, 2) Scarcity of resources, 3) Heterogeneity and changing circumstances, 4) Knowledge of treatment, 5) Values and circumstances, 6) Conflicting priorities, 7) Communication, autonomy and caregiver issues, and 8) Disclosure of risk.

CONCLUSION

These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritizing outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritizing outcomes, and eliciting stakeholder preferences.

Professional caregivers' knowledge, beliefs and attitudes about awareness in advanced dementia: a systematic review of qualitative studies

OBJECTIVES

Awareness can be defined as a response to, or evaluation of, an aspect of one's situation or internal state. Awareness becomes impaired as dementia progresses; however, the exact nature and degree of impairment in advanced dementia remains unclear. The extent to which caregivers understand or make assumptions about the level and nature of awareness in advanced dementia may have a significant impact on their ability to appropriately respond to and care for the person with dementia. This systematic review examines the literature regarding professional caregiver perceptions about awareness in advanced dementia.

DESIGN

A systematic search of online literature databases (PsychInfo, Medline, Embase, CINAHL) was conducted up to January 15, 2018, using a range of search terms related to dementia, awareness and caregiver attitudes.

RESULTS

The systematic review included a total of 10 qualitative studies that were heterogeneous in aspects of design, including analyses. Narrative synthesis was used to integrate results. Four major themes were identified from review of the papers: how professional caregivers defined awareness; professional caregiver beliefs about what influences the expression of awareness; professional caregiver beliefs around how to assess awareness in advanced dementia; and the perceived impact of episodes of increased awareness on the person with dementia and caregiver. Sub-themes were identified within each of these areas.

CONCLUSION

This review highlights the importance of professional caregiver perceptions of awareness in advanced dementia. Supporting professional caregivers to assess and understand the nature of awareness in advanced dementia would improve their approach to care and outcomes for people with dementia.

Thematic analysis of blog narratives written by people with Alzheimer's disease and other dementias and care partners

Limited research takes a socio-biographical approach to study the experiences and perspectives of individuals affected by Alzheimer’s disease and related dementias. The purpose of this study was to thematically analyze blog narratives written by people with Alzheimer’s disease and related dementia and care partners in order to increase understanding of their experiences. Nineteen blogs written by people with Alzheimer’s disease and related dementia and 44 blogs written by care partners were analyzed. The first two authors utilized line-by-line open coding to analyze five posts from each group for the development of a codebook. Using NVivo software, the first author proceeded to code the remaining blogs for emergent themes and subcategories. Emergent themes included (1) effects of Alzheimer’s disease and related dementia on the person with Alzheimer’s disease and related dementia and/or the care partner; (2) seeing the positives; (3) feeling out of control; (4) advocacy and empowerment; (5) coping mechanisms and compensatory strategies; and (6) candid descriptions of experiences with Alzheimer’s disease and related dementia. These themes also encompassed numerous subcategories that are discussed in this paper. Results from this study provide insights into the experiences of individuals affected by Alzheimer’s disease and related dementia. Writers discussed several topics that are consistent with research on illness narratives of individuals with chronic diseases, including loss of identity, strategies for coping, and poignant descriptions of life with the disease. This study provides information in the form of overlapping themes from first-person perspectives of numerous individuals affected by Alzheimer’s disease and related dementia. This type of data is crucial to understand the experiences of people who live with ADRD.

Engagement and experience of older people with socially assistive robots in home care

Social isolation is one of the most common consequences of older people with dementia, especially for those who live at their own dwellings alone due to limited access to social activities. Research relating to the use of social robots in aged care has increasing attention to facilitating the support to care services for older people with dementia. Particularly less attention has focused on the applicability of social robots in home care services. This paper aims to study the engagement and robot experience of older people with dementia while interacting with a social robot named Betty in the context of home-based care. This paper contributes to the research relating to care service embedded robots by expanding the knowledge regarding longitudinal research in home based care, while there is limited long-term study in this context. The results show that social robots are evident to be able to engage with older people with dementia at home. Consequently, designing social robots in a social context is desirable. While the robots enabled service for the human partner within the social context is possible, there is a need to underpin the concept of personhood to realize personalization of services and its contents to suit individual preferences.

"If it helps someone, then I want to do it": Perspectives of persons living with dementia on research registry participation

Registries are an important platform to which persons with dementia and other cognitive impairments can contribute to research studies. Registries also provide an opportunity for patients to stay informed about current studies. Engaging patients in registry development can increase sustainability of a registry and patient retention in clinical registries. We sought the perspective of persons with dementia and their accompanying family members about their registry participation experiences, barriers and facilitators to participation, and potential avenues for improvement of registry processes such as recruitment, data collection, and knowledge translation. Two semi-structured focus groups with persons with dementia and their family members (n = 18) were conducted and analyzed using thematic content analysis. Participants were recruited from an existing patient registry made up of patients currently being seen in a dementia assessment clinic. The main themes identified included altruistic motives with regards to registry participation; and access to and privacy of personal health information. As electronic health records are becoming more common, understanding barriers and facilitators from the perspectives of people with dementia is essential to inform the future development of cognitive condition-related registries. The results from our focus groups identified engagement strategies and solutions to overcome perceived barriers for individuals experiencing progressive cognitive decline to participate in longitudinal registry projects.

The "Artwork Effect" paradigm: A model for planning and assessing cognitive stimulation for people with dementia through museum visits

This paper proposes a paradigm ("Artwork Effect" paradigm) to study the impact of museum stimulation programs for people with dementia. The literature concerning viewing and making art is considered. The paradigm, comprising qualitative and quantitative measures, is illustrated. The implementation of a shared paradigm of assessment can contribute to the validation of an assessment model to evaluate museum stimulation programs for people with dementia: a low-cost nonpharmacological intervention useful for the stimulation of cognitive functions and for increasing the well-being of people with dementia and their caregivers.

Are Humor Styles of People With Dementia Linked to Greater Purpose in Life?

Objectives

Little is known about humor and purpose in life in people with dementia. Although having a sense of humor is typically associated with positive psychological outcomes, recent evidence suggests that outcomes may vary depending on whether the humor being used is adaptive versus maladaptive. The goal of this study was to determine whether humor styles are predictive of purpose in life in people with dementia.

Methods

Questionnaires were verbally administered to people with mild-to-moderate dementia to measure humor styles and purpose in life.

Results

Adaptive humor styles were associated with purpose in life whereas maladaptive humor styles were not.

Discussion

Having a sense of humor in dementia may be associated with a stronger sense of purpose in life, but it depends on the type of humor used. Results are discussed in the context of understanding the role of humor in the daily lives of people with dementia and implications for care.

Philanthropy and dementia care in Ireland

This paper examines The Atlantic Philanthropies investment in dementia in Ireland and its impact on the dementia landscape, particularly in relation to policy. Atlantic has directly invested €33 million in dementia in Ireland and leveraged a further €51 million from grantees, resulting in a total spend of €83 million between 2011 and 2016. The investment was broad and far reaching, encapsulating support for personalised community-based care, brain health, advocacy, education and training in dementia, culminating in support for the formulation and implementation of the first National Dementia Strategy in Ireland. Investing in the right people was a key feature of the Atlantic programme and one of the main drivers of its success. A close and credible relationship with government was also important for success. So too was an emphasis on evidence and evaluation, which has been a long-standing trait of Atlantic’s involvement in public policy in Ireland, as well as being influential in overall public service reform in the country. It is difficult to determine what the dementia landscape in Ireland might look like if Atlantic had not invested in the area, but even if one accepts the view that change would have come eventually, Atlantic ensured that it came much faster and in a more coherent manner.

Care workers, the unacknowledged persons in person-centred care: A secondary qualitative analysis of UK care home staff interviews

Personhood discourses in dementia care have gained prominence and current care home standards mandate that care should be "person-centred". However, it is unclear how the personhood of staff is construed within the care relationship. This paper aims to explore how the personhood of paid carers of people with dementia can be understood by focussing on the views and experiences of care home staff. We undertook a secondary qualitative analysis of interviews with 25 paid care staff in England, conducted as part of the MARQUE (Managing Agitation and Raising QUality of lifE) study. The authors inductively developed themes around the topic of personhood for staff, contrasting management and care staff perspectives. We found that many care staff are not identified as persons in their own right by their employing institutions, and that there is a general lack of acknowledgment of the moral work of caring that occurs within formal care work. This oversight can reduce the complex relationships of care work to a series of care tasks, challenges care workers' self-worth and self-efficacy, and impede their efforts to deliver person-centred care. We conclude that care staff status as persons in their own right should be explicitly considered in quality standards and supported by employers' policies and practices, not simply for their role in preserving the personhood of people with dementia but for their own sense of valued personhood. Enhancing staff personhood may also result in improved care.

A randomised controlled trial to evaluate the impact of a human rights based approach to dementia care in inpatient ward and care home settings

Background

Although it is widely recognised that adopting a person-centred approach is beneficial in the care of people living with dementia, a gap remains between the rhetoric and the reality of quality care. Some widely adopted care practices can result in the personhood of this group being threatened and their human rights being undermined.

Objectives

To evaluate the impact of applying a human rights based approach in dementia inpatient wards and care homes on the quality of care delivered and the well-being of the person living with dementia.

Design

A cluster randomised design was employed to compare the impact of implementing a human rights based approach intervention (i.e. training, applying the ‘Getting It Right’ assessment tool and receiving booster sessions) at 10 intervention sites with 10 control sites.

Setting

Eight NHS dementia inpatient wards and 12 care homes in the north-west of England.

Participants

People living with dementia who were residing on dementia inpatient wards or in care homes, and staff working at these sites. The aim was to recruit 280 people living with dementia.

Interventions

A sample of staff (an average of 8.9 per site) at each of the sites was trained in a human rights based approach to care, including the application of the ‘Getting It Right’ assessment tool. The tool was then introduced at the site and monthly booster sessions were delivered.

Main outcome measures

The primary outcome measure used in the research was the Quality of Life in Alzheimer’s Disease scale to assess the subjective well-being of the person with dementia. Secondary outcome measures included measures of the quality of care provided (dementia care mapping) and direct measures of the effectiveness of the training in increasing knowledge of and attitudes towards human rights. The study also included an economic evaluation utilising the EuroQol-5 Dimensions, three-level version, and the Adult Social Care Outcomes Toolkit measure.

Results

The study recruited 439 people living with dementia: 213 to the intervention arm and 226 to the control arm. Primary outcome data were analysed using a linear mixed model. There were no significant differences found in the reported quality of life of residents between the control and intervention groups after the intervention [F(1,16.51) = 3.63;p = 0.074]. The mean difference between the groups was 1.48 (95% confidence interval –7.86 to 10.82).

Conclusions

Despite the fact that the training increased staff knowledge of and positive attitudes towards human rights, and although there were some changes in staff decision-making strategies in clinical situations, there was no change in the quality of care provided or in the reported well-being of people living with dementia in these settings. This led to questions about the efficacy of training in bringing about cultural change and improving care practices.

Limitations

There was limited uptake of the training and booster sessions that were integral to the intervention.

Future work

Future work could usefully focus on understanding the difficulty in translating change in attitude and knowledge into behaviour.

Trial registration

Current Controlled Trials ISRCTN94553028.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 13. See the NIHR Journals Library website for further project information.

Weaving social reality around the grandparent/great-grandparent with dementia to maintain relational presence: A verbal and non-verbal dementia interactions model

We proposed a dementia interactions model based on analyses of five focus groups with grandchildren of grandparents with dementia. Interactions with their grandparent with dementia motivate grandchildren to maintain connection with a grandparent who is relationally present. To do so, they weave a social reality around the grandparent. To help the grandparent remain connected, grandchildren engage in scripts and routines and employ three intertwined psychological processes: perspective taking, vigilance, and knowledge about the grandparent's preferences, personality, state of mind, and context. Grandchildren use four relationship anchors to help the grandparent remain relationally present: family members, meaningful sensory objects and activities, physical space/context, and themselves. Implications for improving social interactions with close others with dementia are discussed.

The intersection of culture in the provision of dementia care: A systematic review

AIMS AND OBJECTIVES

To understand the intersection of healthcare professionals' and care workers' culture and their provision of person-centred care for people with dementia.

BACKGROUND

Due to the nature of global immigration and recruitment strategies, health care is provided by a culturally diverse workforce. Consequently, there is a need to understand healthcare professionals' and care workers' cultural values of illness, disease and dementia. Cultural values and beliefs regarding dementia and care of the older person differ, and currently, there is a lack of clarity regarding the intersection of culture in the provision of person-centred dementia care.

METHOD

A search of the following databases was completed: Medline, CINAHL, Psychology and Behavioural Sciences, PsycINFO and PubMed for papers published from 1st January 2006 to 31st July 2016.

RESULTS

A total of seven qualitative studies met the inclusion and exclusion criteria, all explored the impact of healthcare professionals' and care workers' culture in relation to their provision of person-centred dementia care. A meta-synthesis of the data from these studies identified four themes: cultural perceptions of dementia, illness and older people; impact of cultural perceptions on service use; acculturation of the workforce; and cross-cultural communication.

CONCLUSION

Limited evidence was found on the impact of healthcare professionals' and care workers' culture on their provision of person-centred dementia care. The intersection of culture and dementia included the understanding of dementia, care and family roles. Acculturation of migrant healthcare workers to the culture of the host country, workplace, and support with the communication was identified as necessary for the provision of person-centred dementia care.

RELEVANCE TO CLINICAL PRACTICE

Open access education and training to support communication is required, alongside the development of robust interventions to support the process of acculturation of migrant healthcare professionals and care workers to provide culturally competent person-centred dementia care.

The legal implications of dementia in the workplace: establishing a cross-disciplinary research agenda

Dementia is a growing issue in the United Kingdom (UK) with over 800,000 people affected. Of these people, in excess of 40,000 are aged under 65 years. Thus, a significant number of individuals may be experiencing symptoms of dementia while in employment. In addition, as working lives extend, the potential impact of dementia on the workplace could be substantial. However, to date, there has been little research on experiences of dementia in the workplace. The research that exists highlights the lack of support for workers with dementia. Dementia may be considered to be a disability under the Equality Act 2010. Therefore, the legislation potentially provides a framework for individuals to request that their employer make reasonable adjustments to support their continued employment. International human rights law is potentially another tool that could be utilised to obtain necessary adjustments. This paper argues that in developing the evidence base on workplace experiences of dementia, it is important that the legal framework be considered. This paper reviews the existing literature on dementia in the workplace and embeds this in the legislative framework in order to establish a cross-disciplinary research agenda. While the paper focuses on the UK legal context, the argument presented in the paper is still relevant to other national contexts.

Stress as Experienced by People with Dementia: An Interpretative Phenomenological Analysis

Health and social care research on stress in dementia has predominantly considered the stress experienced by family and professional carers. Focus on the person with dementia has frequently laid emphasis on the impact of stress-related behaviour on others and how such behaviour might be 'managed'. This paper describes a qualitative study which gives voice to people with dementia on the subject of stress and responds to the need for a better understanding of stress as it is experienced by people with dementia themselves. An interpretative phenomenological analysis was conducted on data collected from a purposive sample of people diagnosed with varying types of dementia from across Scotland. Discussions across five focus groups consisting of 21 participants with dementia in total generated data which was audio and video recorded, and analysed thematically. Five key themes emerged, described in the participants' own words, which were: (1) 'Something's torn, your life's torn'; (2) 'Families can bring stress'; (3) 'It's the stress of living with dementia'; (4) 'A whole new set of rules'; and (5) 'It's our lives and we'll get it under control ourselves'. These themes reflect experiences of loss, challenges to one's sense of self, relationship dynamics, living with the symptoms of dementia, learning to do things differently and establishing coping mechanisms that provide control. Study participants illustrated individual potential for adapting and coping with some of the most stressful aspects of living with dementia, challenging assumptions of inevitable fixed decline and progressive vulnerability to stress. Participants describe a process of recovery in their perceptions of self-worth, purpose and value in life following diagnosis.

Hanging on to Some Autonomy in Decisionmaking: How do Spouse Carers Support this?

In Australia, the majority of people with dementia live in the community with informal care provided by family, commonly a spouse. A diagnosis of dementia is a threat to one's personhood and is often accompanied by perceptions of future dependency, which will involve the inability to carry out conventional roles and complete everyday tasks including making decisions. Being able to make decisions, however, is part of being a 'person' and it is through relationships that personhood is defined and constructed. In face-to-face interviews with seven couples (a carer and person with dementia dyad) and two spouse carers, this study explored why, and how, spouse carers support continued involvement in decision-making for people with dementia. The findings highlight the importance of loving and respectful relationships in the development of strategies to support continued decision-making for people with dementia.

Making sense of dementia: Exploring the use of the Markers of Assimilation of Problematic Experiences in Dementia scale to understand how couples process a diagnosis of dementia

This qualitative study aimed to see whether the Markers of Assimilation of Problematic Experiences in Dementia (MAPED) scale could be applied to couples. It aimed to explore the interactions between couples and how this affected the levels of assimilation. Semi-structured interviews were conducted with four heterosexual couples. The results suggested that MAPED can be usefully applied to couples. It highlighted the oscillating process which couples undergo as they process a dementia diagnosis. This supports the notion that making sense of a dementia diagnosis is not static, but a fluctuating and ever changing process. The strategies couples employed either facilitated or prevented the expression and integration of the Problematic Voice. The study highlights the importance of supporting couples together during a dementia diagnosis.

Dementia: Sustaining Self in the Face of Cognitive Decline

It is argued that the way in which we view a person with dementia can have a significant effect on the level of disability and wellbeing of the person. There is a divergence between a belief that the self disintegrates, leaving a non-person, and a belief that the self remains but is misplaced and can be maintained with the appropriate approach from others. This article seeks to examine the differing approaches to self and personhood in dementia care, and establish ways of approaching care for the person with dementia which may limit the extent of disability in the face of cognitive decline.

Spousal Caregiver Perspectives on a Person-Centered Social Program for Partners With Dementia

This qualitative study explored spousal caregiver perspectives on the experience and impact of a person-centered social program for partners with dementia. Interviews with 5 caregivers and the spouses with dementia were conducted 7 to 8 months after the program ended to explore the sustained impact of the program. Interpretative phenomenological analysis was used to support in-depth exploration of interviews. Three themes emerged including benefits of the program for caregivers, initial expectations and later perspectives of caregivers about the program, and conflicting values and perspectives between caregivers and the spouses. These findings suggest participation in a person-centered social program by people with dementia benefits their caregivers, by meeting the caregivers' desire for their spouses to increase social participation and engagement in meaningful activities. Participation in the program provided a sustained benefit to one couple in particular, by encouraging the caregiver to resume arranging activities the couple once enjoyed but now had difficulty pursuing.

Dementia and representative democracy: Exploring challenges and implications for democratic citizenship

Despite growing recognition of the rights of people with dementia for full citizenship, issues related to democracy, whether from theoretical or practical perspectives, remain neglected. Especially since discourses on dementia have expanded to this rights-based approach, it is imperative to begin to examine the meanings and practices of democracy within a context of dementia. Accordingly, the purpose of this article is to assess implications of dementia in the context of democracy. Rather than surveying the variety of democratic concepts, it will focus the analytical framework on representative democracy and then outline several challenges to and for representative democracy and citizens with dementia. The intention is to begin to identify paths for ensuring representation, inclusion and participation for those who have dementia.

Creating space for citizenship: The impact of group structure on validating the voices of people with dementia

Recently, there has been increasing attention given to finding ways to help people diagnosed with dementia ‘live well’ with their condition. Frequently however, the attention has been placed on the family care partner as the foundation for creating a context that supports the person with dementia to live well. A recent participatory action research (PAR) study highlighted the importance of beginning to challenge some of the assumptions around how best to include family, especially within a context of supporting citizenship. Three advisory groups consisting of 20 people with dementia, 13 care partners, and three service providers, were set up in three locations across Canada to help develop a self-management program for people with dementia. The hubs met monthly for up to two years. One of the topics that emerged as extremely important to consider in the structuring of the program revolved around whether or not these groups should be segregated to include only people with dementia. A thematic analysis of these ongoing discussions coalesced around four inter-related themes: creating safe spaces; maintaining voice and being heard; managing the balancing act; and the importance of solidarity. Underpinning these discussions was the fifth theme, recognition that ‘ one size doesn’t fit all’. Overall an important finding was that the presence of family care-partners could have unintended consequences in relation to creating the space for active citizenship to occur in small groups of people with dementia although it could also offer some opportunities. The involvement of care partners in groups with people with dementia is clearly one that is complex without an obvious answer and dependent on a variety of factors to inform a solution, which can and should be questioned and revisited.

Narrative citizenship, resilience and inclusion with dementia: On the inside or on the outside of physical and social places

There has been little research that addresses the importance of place in enabling resilience and citizenship – most to date focussing on these as a characteristic of the individual. This paper reports on findings from a qualitative study that aimed to explore the everyday experiences of living with dementia within rural and semi-urban communities. Data collection included a sequence of four research diaries and interviews with 13 families living at home with dementia and interviews with service providers and commissioners (a total of 57 diaries, 69 interviews with people living with dementia and 6 interviews with service providers and commissioners). Key themes identified included: Others Knowing and Responding; Socially Withdrawing and Feeling Excluded; Sustaining and Changing Activities; Belonging and Estrangement from Place; Engaging Services and Supports. The study found that familiarity with people and place can be supportive, and these factors support a narrative citizenship in which people can tell a story of inclusion and feeling on the inside. However, this familiarity with place may also create a social barrier and a sense of estrangement, or being on the outside. Narrative citizenship allows us to explore how people with dementia position themselves in relation to others and in so doing, negotiate their own and other’s understandings of dementia. It also allows for people to tell stories about themselves in relation to their sense of belonging in a social and physical place, which augment the personal and political approaches to citizenship and thus offers an approach that enhances individualised yet collective understandings of living with dementia.

Patterns of social engagement in the transition to later life

As social roles in later life are shaped by significant life events and changes occurring in the late-life transition, examining social engagement in midlife may provide a context for interpreting the ageing social identity. This is particularly important for women, who are heavily dependent on social relationships and are more influenced by social losses and change.

OBJECTIVE

To examine major social changes occurring in the decade prior to late-life, starting from approximately 45-55 years of age.

STUDY DESIGN

The study accessed data from the longitudinal prospective Women's Healthy Ageing Project (WHAP). Participants were 493 women who had completed at least one assessment in the first 12 years of the study.

RESULTS

Living with a partner was common and stable amongst participants, while the proportion with children still at home decreased markedly (79-44%). Full-time employment also decreased as participants approached the average retirement age (40-13%). Volunteer work was popular throughout the study, increasing slightly with age, and minding grandchildren was common at the end of the study period (80%).

CONCLUSIONS

Taken together, these findings suggest a notable deficit in participants' social lives as they transition into later life, but with some evidence of compensation by increasing other social activities.

When Actions Speak Louder Than Words: Extending the Reach of Qualitative Data Collecting

Through the lens of a study exploring dementia care partnering, the purpose of this methods article is to focus on the role of artifacts and embodied data in data collection. In addition, it illustrates how to use a range of data collecting methods. The article identifies benefits of additional data collecting methods to research and care. These include the need to expand data collecting methods beyond spoken word, integrate a range of data collecting approaches into research courses across disciplines, increase support of qualitative research, and advocate for greater inclusivity in research. Data collecting approaches can also have implications for quality of life among persons often excluded from research-building endeavors. They can contribute to the unfolding of new findings, which can influence care practices.

Conceptualizaciones sobre la atención a personas con demencia en residencias de mayores

A pesar de la importancia de las percepciones familiares en el análisis de la atención en residencias de mayores, apenas se han indagado estos ascpetcos. El objetivo de este estudio es conocer las preferencias y las áreas de mejora percibidas por los familiares sobre los cuidados a personas con demencia. Se realizó un estudio cualitativo, a partir de la Teoría Fundamentada, combinando dos técnicas de recogida de datos (observación participante y entrevistas en profundidad) en una muestra teórica de familiares de personas con demencia institucionalizadas. El modelo de atención óptima a personas con demencia, percibido por los participantes, se basó en una atención especializada e individualizada y en la participación de la familia en el cuidado. Entre las áreas de mejora se incluyeron aspectos relacionados con una mayor formación específica en Geriatría, relaciones humanas y con la cultura del trabajo institucional. Frente a la vigente tendencia de tecnificación del cuidado, las familias exigen una atención personalizada y en pequeña escala, donde ellas mismas sean parte activa del proceso de atención.

Computer modeling with randomized-controlled trial data informs the development of person-centered aged care homes

AIM

To answer questions on the essential components (services, operations and resources) of a person-centered aged care home (iHome) using computer simulation.

MATERIALS & METHODS

iHome was developed with AnyLogic software using extant study data obtained from 60 Australian aged care homes, 900+ clients and 700+ aged care staff. Bayesian analysis of simulated trial data will determine the influence of different iHome characteristics on care service quality and client outcomes. Interim results: A person-centered aged care home (socio-cultural context) and care/lifestyle services (interactional environment) can produce positive outcomes for aged care clients (subjective experiences) in the simulated environment.

CONCLUSION

Further testing will define essential characteristics of a person-centered care home.

A qualitative study of nursing assistants' awareness of person-centred approaches to dementia care

Recently, the number of education programmes addressing person-centred approaches to long-term residential dementia care has increased, and nursing assistants (NAs) are often the target audience. The effectiveness of employee education programmes is actively debated, and our objective is to contribute to this discussion by exploring the knowledge NAs acquire through practice. We examined approaches to person-centred care generated during a series of interviews with NAs, and compared these to the content of five frameworks for person-centred dementia care. Our results suggest that although NAs acquire significant knowledge about person-centred dementia care during the course of their work, application of person-centred care strategies varies across NAs. We propose ways of enhancing NA education in order to address gaps in knowledge. We also recommend sustained attention to organisational factors that contribute to variability in practice.

Discovering what works well: exploring quality dementia care in hospital wards using an appreciative inquiry approach

AIMS AND OBJECTIVES

To explore the quality dementia care in two geriatric hospital wards using appreciative inquiry with formal care workers and family members of inpatients with dementia.

BACKGROUND

Care models such as person-centred and relationship-centred care have been developed to explain what 'quality' dementia care should be. However, their usefulness and relevance to clinicians has been questioned.

DESIGN

Using an exploratory qualitative design within an appreciative inquiry framework, 33 care workers working in a geriatric hospital and 10 family members of patients with dementia were interviewed.

METHODS

Open-ended questions were asked to encourage care workers to narrate positive care experiences when the care was perceived to be at its best and to identify what made these experiences possible. Interviews were audio-taped and transcribed whilst data were analysed thematically using a qualitative data analysis software to assist in data management.

RESULTS

Positive care experiences can be understood within five care processes, namely building a relationship between the 'extended' dementia care triad, providing 'quality time' and 'care in time', going the 'extra mile', attending to the psychosocial needs and attending to the physical needs with a 'human touch'. Factors facilitating these positive care experiences included personal attributes of care workers, and organisational, environmental and contextual factors.

CONCLUSIONS

This study provides an alternative and pragmatic approach to understanding quality dementia care and complements the body of knowledge on factors influencing dementia care practices in hospitals.

RELEVANCE TO CLINICAL PRACTICE

By understanding the components of quality dementia care and how these can be achieved from different stakeholders, it is possible to develop strategies aimed at improving the care offered to patients with dementia in hospitals.

Experience of anaesthesia nurses of perioperative communication in hip fracture patients with dementia

BACKGROUND

Perioperative care in hip fracture patients with dementia can be complex. There is currently little scientific evidence on how care should be undertaken.

AIMS

The aim of the study was to describe the experience of anaesthesia nurses of the difficulties that emerge in care situations and how communication with patients can be maintained in the perioperative setting of hip fracture surgery.

METHODS

Individual interviews were conducted with ten anaesthesia nurses (5 men and 5 women). The interviews were carried out at a university hospital in Gothenburg (Sweden), and the data were analysed using qualitative content analysis.

FINDINGS

Three main response categories were discerned: 'Communication', 'Dementia as a special issue' and 'Practical issues'. Dementia was viewed as one of the most difficult and shifting diseases an individual may suffer from. Time must be allocated to communicate clearly and patiently, to meticulously plan and carry out care while providing distinct information to enable patient participation. Establishing a mental bridgehead by confirming the patients' perceptions/feelings significantly reduced distress in a majority of the patients. A holistic and respectful approach was deemed mandatory at all times. Patients are sometimes dependent on recognition, so that small personal items brought close to the patient during surgery can calm the patient. State-of-the-art analgesia and anxiolytic medications are mandatory.

CONCLUSIONS

Perioperative problems can be overcome with patience, empathy and profound knowledge of how patients with dementia respond prior to surgery. Our results may serve as a source for future care and provide information about hospital settings for better perioperative care in patients with dementia.

The impact of oral health on body image and social interactions among elders in long-term care

OBJECTIVE

The objective of this study was to explore how social interactions and body image are influenced by perceived oral health among older people who live in long-term care facilities.

BACKGROUND

Social interactions among frail elders in long-term care (LTC) facilities are limited, but to what extent body image and oral health influence their social relations is poorly understood. A positive body image and the perception of adequate oral health are linked to increased social contacts, as well as improved health and well-being irrespective of age. However, as frailty increases, it is unclear whether appearance and oral health priorities remain stable.

MATERIALS AND METHODS

Open-ended interviews were conducted with a purposefully selected group of cognitively intact, older men and women who exhibited varying degrees of frailty, social engagement and oral health conditions and lived in one of seven long-term care facilities. The interviews were analysed using a constant comparative technique, and a second interview with participants checked the trustworthiness of the analysis.

RESULTS

Three major categories were expressed by the participants: (1) My mouth is fine; (2) It depends; and (3) Not that important. Within each category, there were several contributing and influencing factors.

CONCLUSIONS

Social interactions among residents in LTC may be negatively impacted by poor oral health, but only if other personal and social issues are less bothersome than conditions with the mouth.