The role and impact of therapeutic counselling on the emotional experience of adults living with dementia: A systematic review

Introduction There is limited psychological support available to help people living with dementia to deal with the emotional consequences of their condition. Anxiety and depression are commonly experienced in this population, yet the use of counselling and psychotherapeutic interventions is not well documented. Aim This systematic review sought to understand the current knowledge on the role and impact of therapeutic counselling on the emotional experience of adults living with dementia. Methods Qualitative and quantitative research designs were accepted for review. A comprehensive search of the main biomedical, nursing and other specialist databases was performed to access articles published between 2015 and 2022. Trial registers and academic journals were also searched. 43 original studies were included: qualitative (n = 15); RCTs (n = 9); other designs (n = 19); plus eight systematic reviews. Results The majority of studies were conducted in Europe, the United Kingdom in particular, although a range of countries from across the globe were represented. The combined evidence from the different study designs suggest a range of ways that people living with different stages of dementia can participate in, and gain emotional benefit from, therapeutic counselling. Key themes identified: (1) The emotional and well-being benefits of therapeutic counselling; (2) No one size fits all - relational and tailored approaches driven by person-centred values; (3) Training, supervision and building community for counsellors; (4) Involvement of people with dementia in therapeutic interventions. Conclusions Our findings from this systematic review show that different therapeutic approaches have been tested with people at different stages of a dementia diagnosis. The results suggest the value of therapeutic counselling as a supportive medium to help with the processing and coping of difficult emotions and feelings across the trajectory of a dementia illness.

Long-term impact of the COVID-19 pandemic on the quality of life of people with dementia and their family carers

INTRODUCTION

Few studies have longitudinally mapped quality of life (QoL) trajectories of newly diagnosed people with dementia and their carers, particularly during coronavirus disease-2019 (COVID-19).

METHODS

In a UK cohort study, 261 newly diagnosed people with dementia and 206 family carers were assessed prior to the pandemic (July 2019-March 2020), followed up after the first lockdown (July-October 2020) and then again a year and 2 years later. Latent growth curve modelling examined the level and change of QoL over the four time-points using dementia-specific QoL measures (DEMQOL and C-DEMQOL).

RESULTS

Despite variations in individual change scores, our results suggest that generally people with dementia maintained their QoL during the pandemic and experienced some increase towards the end of the period. This contrasted with carers who reported a general deterioration in their QoL over the same period. 'Confidence in future' and 'Feeling supported' were the only carer QoL subscales to show some recovery post-pandemic.

DISCUSSION

It is positive that even during a period of global disruption, decline in QoL is not inevitable following the onset of dementia. However, it is of concern that carer QoL declined during this same period even after COVID-19 restrictions had been lifted. Carers play an invaluable role in the lives of people with dementia and wider society, and our findings suggest that, post-pandemic, they may require greater support to maintain their QoL.

Dementia care in gerontological social work: emerging issues and challenges in Saudi Arabia

The issues and challenges in the current state of gerontological social work policy, practice, and education related to dementia care in Saudi Arabia are discussed in this article. The following primary issues were explored: (1) the impact of the biomedical model's global dominance on gerontological social work policy and research for dementia care and health promotion; (2) the position of the older adults in Middle Eastern nations and its connection to the lack of gerontological social work policies, programs, and care services for older adults with dementia and their family caregivers; (3) the effect of the profession of social work's lack of recognition on the potential evolution of gerontological social work practice in dementia care; (4) the state of dementia patients' rights, dementia patients' safety, and dementia patients' rights to self-determination on the gerontological social work support provided for older adults with dementia; (5) the unequal distribution of dementia care resources and gerontological social work; and (6) the social work education programs' inability to supply the market with sufficient number of skilled gerontological social workers and its effect on the advancement of dementia care in gerontological social work practice. Approaches for advancing policy, practice, and education are provided to support the evolution of gerontological social work in dementia care in the region.

Waiting for home: The experience of delayed discharge for people with dementia

INTRODUCTION

Individuals who remain in hospital once their health has stabilised experience delayed discharge. This often occurs for people with dementia when care needs exceed what can be managed at home. There is little research that takes into account the experience and needs of these patients. This Interpretive Description (ID) study, theoretically grounded in personhood and social citizenship perspectives, focused on the perspectives of people with dementia experiencing delayed discharge to address this gap in research and to better understand how nursing care can be improved for them.

METHODS

Twenty-one individuals participated in this study: eight patient participants experiencing delayed discharge and living with dementia, six family members, and seven nurses. Data collection methods primarily included participant observations, totalling 100 h of observations. Fourteen semi-structured interviews were also conducted with family members and nurses and with one patient participant. Informal conversations were undertaken with patient participants who did not take part in interviews.

RESULTS

Thematic analysis resulted in three main themes, encapsulating the patients' experiences: (1) Living and Waiting; (2) Distress and Behaviours; and (3) Looking Beyond the Designation. Findings are discussed in the context of the passive nature of delayed discharge care, the need for person-centred care, and prevailing discourses around the behavioural symptoms of dementia.

CONCLUSION

Implications for nursing practice include the need to acknowledge and foster the abilities of people with dementia. The behaviour narrative and labelling prevalent in hospitals must also be challenged. Lastly, nurses need to recognise the significant transition that is the delayed discharge experience, especially for people with dementia. This study advocates for person-centred and inclusive nursing care, where ongoing needs are recognised and addressed, particularly for people with dementia experiencing delayed discharge, who are waiting for home.

'He is just getting old, you know': the role of cultural and health beliefs in shaping the help-seeking process of family members caring for persons with dementia in Vietnam

OBJECTIVES

This study aims to examine the help-seeking process of family caregivers for persons with dementia (PWD) in Vietnam, and how health and cultural beliefs shape this process.

DESIGN

Twenty family caregivers of PWD at a geriatric hospital in Northern Vietnam were recruited. A total of 30 face-to-face, semi-structured interviews, including 10 follow-up interviews, were conducted. Structural coding was used first to guide data analysis through four structural codes consistent with the four stages of the help-seeking model: (1) disease and symptom experience; (2) explanatory models for symptom appraisal; (3) decision to seek help; and (4) contact with the sources of help. Then thematic coding was used for more detailed and data-driven initial codes to emerge from the data.

RESULTS

Cultural and health beliefs, particularly collectivist values, such as familism and filial piety, shaped each stage of Vietnamese family caregivers' help-seeking process. Caregivers experienced different PWD's symptoms and adopted a mixed explanatory model combining biomedical and folk beliefs to explain the causes of dementia. They highly valued independence, autonomy, devotion to their family, and self-sacrifice, making these values the driving force underlying their self-reliance regime in caregiving. Help-seeking was often delayed until caregivers considered the situation to be beyond their own capacity to manage independently. The family was always the primary informal source of support for caregivers, with additional help sought from friends, neighbors, and religious facilities. Health professionals, if available, were also an important formal source for medical advice.

CONCLUSIONS

The results highlight the importance of culture and health beliefs in shaping caregivers' help-seeking process, and advocate the needs of service development targeting not only Vietnamese family caregivers for PWD, but also caregivers sharing similar collectivist culture in different areas. Interventions and services that are consistent with their values of self-sacrifice, devotion to family, autonomy, and self-reliance are much needed.

The Bubble of Normalisation: A Qualitative Study of Carers of People With Dementia Who Do Not Seek Help for a Diagnosis

OBJECTIVE

Improving dementia diagnosis rates are a key feature of dementia strategy and policy worldwide. This study aimed to explore the experience of carers of people diagnosed with dementia during or following a hospital admission in order to identify factors that had prevented them from seeking help beforehand. Semi-structured interviews were conducted with 12 informal carers including adults caring for a parent, a friend or a spouse diagnosed with dementia between 2010-2019, following an acute hospital admission for a physical health problem, having not sought help previously.

MAIN FINDINGS

Carers created a 'bubble of normalisation' around themselves and the person living with dementia (PLWD) to reject the label of dementia and protect the PLWD from a loss of independence, discrimination and prejudice they felt would be the result of a diagnosis. Carers struggled to talk to the PLWD about dementia reinforcing denial and stigma. Post-diagnosis carers felt unsupported and questioned the value of diagnosis.

PRINCIPAL CONCLUSIONS

Stigma related to images of dementia as a disease that takes away independence and identity prevented discussion about dementia between carers and the PLWD. A lack of open discussion about memory concerns between health care professionals and carers also served to delay diagnosis.

Experiences of Carers and People with Dementia from Ethnic Minority Groups Managing Eating and Drinking at Home in the United Kingdom

Eating and drinking difficulties, such as loss of appetite and swallowing problems, are common in dementia, but little is known about the experiences of ethnic minority groups who are managing these difficulties at home. The purpose of our study was to explore the meaning of food, the impact of dementia on eating and drinking, and carers’ experiences of support. We undertook semi-structured interviews with 17 carers and people with dementia from ethnic minority backgrounds living in England, using thematic analysis to analyse the data. Food/drink had strong links to identity, culture and emotions. Providing culturally familiar foods, celebrating traditional festivals and supporting previous food-related roles promoted reminiscence, which encouraged the people living with dementia to eat and drink, as did social interactions, although these could lead to distress in those with more advanced dementia. Food choices were also influenced by carer strain, generational differences and the impact of health conditions. Despite a strong sense of duty to care for relatives at home, there was low awareness of community support services. The carers expressed a need for culturally tailored support for managing dementia-related eating and drinking difficulties at home. Healthcare professionals must provide contextually relevant advice to carers, being mindful of how cultural backgrounds can affect dietary choices.

Dementia-friendliness - A matter of knowledge, responsibility, dignity, and illusion

Worldwide, dementia-friendly initiatives are being developed primarily based on and driven by political strategies. Health professionals, local government officials, and initiators alike are working to create dementia-friendly communities, but little is known about how professionals discursively construct dementia-friendliness and how their various interpretations affect current practices in the field. This study aimed to explore how those involved in establishing dementia-friendly initiatives, nursing homes, and dementia villages ascribe meaning to and construct dementia-friendliness. Three focus groups were conducted, including two with five health professionals each from two nursing homes for people with dementia and one with seven initiators involved in the development and establishment of nursing homes and dementia villages. We further conducted a small-group interview with a consultant and a project worker representing a local authority. Seeing dementia-friendliness as a discursive construction, we conducted a critical discourse analysis, taking inspiration from the work of Norman Fairclough. The surveyed professionals reported relying on knowledge, responsibility, dignity, and illusion discourses to construct dementia-friendliness. Our results also indicated that the construct of dementia-friendliness fosters discursive battles indicated by dilemmas concerning the adequate and dignified treatment of people with dementia and health professionals' critical stances toward the construct of dementia-friendliness.

Participation as means for adaptation in dementia: a conceptual model

OBJECTIVES

There are a number of conceptual models of dementia, capturing a range of biopsychosocial factors. Few integrate the lived experience of dementia. The aim of this study was to develop a conceptualisation grounded in the first-hand accounts of living with the condition and reflecting its complexity.

METHOD

The study was conducted within an explanatory, critical realist paradigm. An overarching narrative approach, informed by a previously completed systematic review and metasynthesis of research on the lived experience of dementia and the assumptions of complexity theory, was used to guide data collection and analysis. Data were contributed by 31 adults, including 12 people living with dementia and 19 family caregivers.

RESULTS

The experience of living with dementia was conceptualised as a process of adaptation through participation, emerging from ongoing, dynamic and nonlinear interactions between the adaptive capacity of a person with dementia and the adaptive capacity within the environment. The proposed conceptual model describes contexts and mechanisms which shape this capacity. It identifies a range of potential outcomes in dementia. These outcomes reflect interactions and the degree of match between the adaptive capacity of a person and the adaptive capacity within the environment.

CONCLUSION

By recognising and exploring the potential for adaptation and enduring participation in dementia, findings of this research can support practitioners in facilitating positive outcomes for people affected by the condition.

Gender and dementia national strategy policymaking: Working toward health equity in Canada through gender-based analysis plus

This article discusses the results of a content and critical discourse analysis of Canadian federal policy documentation relating to the development of a national Canadian dementia strategy. These documents span from 2013 and focus upon Canadian federal policy directives and directions up to the release, and including the release, of a national strategy in June 2019. The analyses, supplemented by a subtextual examination of these documents guided by Bacchi's (2012) "What's the Problem Represented to be?" framework, focuses upon the treatment of gender in policy documentation and the specific gender related policy framework, known as GBA+ (gender-based analysis and intersectionality), which is intended to bring about health equity to disadvantaged groups. As women, particularly, working class women and their carers, as well as women with additional intersecting factors, such as being lesbian or bisexual, are less likely to receive the dementia related care and services they need, precipitating a premature move to residential care, GBA+ is an essential policy framework in the attempt to address these inequities. However, findings point to a superficial treatment of gender, GBA and GBA+ in federal policy documents and lack a meaningful invocation of women's gendered and intersectional lived experiences of dementia. Additionally, the Canadian federal government's Dementia Strategy for Canada: Together We Aspire (2019) is grounded in a rendition of citizenship that do not work to unearth the complex relationships between citizenship, old age, gender and intersectional factors. As a result, the Dementia Strategy for Canada: Together We Aspire (2019) presents a version of citizenship that homogenizes older adults and prevents representations of older adults as diverse, complex and continually changing groupings. Therefore, inspired by Bartlett et al. (2018), I advocate for the application of a feminist and intersectional citizenship lens in Canadian federal dementia-related policymaking documentation going forward.

Reflections on a personalized cognitive rehabilitation intervention: Experiences of people living with dementia and their carers participating in the GREAT trial

Cognitive rehabilitation for people living with early-stage dementia improves functional ability in areas targeted in the therapy, but little is known about how participants experience this intervention. This qualitative paper investigates participants' views about a cognitive rehabilitation intervention in a randomized controlled trial (the GREAT trial) and aims to help explain and interpret the findings and to inform further intervention development. Using in-depth thematic analysis, 43 semi-structured interviews (35 individual and 8 dyadic) were conducted with 25 people living with dementia and 26 family carers from three sites. The person-centred, individualized approach was valued. Some participants' views about dementia were questioned as a consequence of taking part in the therapy; they considered the effectiveness of the intervention in the context of the progressive nature of the condition. Certain participants continued to be doubtful, focussing on the inevitability of decline, rather than the possibility of reablement. Such views may have influenced engagement. The therapeutic relationship played a vital role as it was how personalized care was provided and participants' views had changed positively. Therapists engendered greater confidence and reduced anxiety and social isolation. Positive responses support personalized rehabilitative care to address the specific needs of people living with dementia.

Everybody S***s: how defecation stigma reduces care quality in dementia

Purpose

This paper aims to raise awareness of the ways in which faecal incontinence can impact the provision of dementia care by examining this through the lens of stigma.

Design/methodology/approach

This paper contains a scoping review of available literature relating to faecal incontinence, dementia and stigma.

Findings

Literature was organised into three themes: the origins of the stigma, the purpose of stigma and the care context.

Research limitations/implications

Limitations of this paper include the lack of literature discussing faecal incontinence and dementia in relation to stigma.

Practical implications

Stigma regarding faecal incontinence has the potential to impact quality of life of people with a dementia and contributes towards the invisible work of unqualified care workers.

Originality/value

Stigma and faecal incontinence have only a small amount of research around them in residential dementia care.

Hospital length of stay among older people treated with flexible and integrative psychiatric service models in Germany

OBJECTIVE

Since 2012, a new law (§64b, Book V of the Social Security Code [SGB V]) regulates the implementation of flexible and integrative psychiatric treatment projects (FIT64b) in Germany. FIT64b allows rapid discharge of patients from inpatient to outpatient settings and cost reductions of hospital stays. Several psychiatric centres exclusively provide FIT64b; others provide FIT64b alongside with standard health care. The aim of the study was to assess the average hospital length of stay (AHLS) of older patients with mental illness included in FIT64b projects.

METHODS

A secondary data analysis was conducted using administrative data from eight German mental health centres providing FIT64b. The effects of gender, age, type of centre, and main diagnosis on AHLS were calculated for all older patients with age 65 years or older (n = 3495) treated in FIT64b in the year 2016. Data were analysed with descriptive statistics and robust multiway procedures.

RESULTS

The AHLS of older people with mental illness was 4.8 (SD = 11.5) days. The AHLS was shorter in centres exclusively providing FIT64b than in centres providing FIT64b alongside with standard health care: 3.2 (SD = 6.4) vs 8.4 (SD = 17.8) days, P = .001. This difference was particularly marked among patients with schizophrenia spectrum disorders, mood disorders, and neurotic, stress-related, and somatoform disorders.

CONCLUSIONS

FIT64b relates to very short AHLS even among older people. Centres using FIT64b alongside with standard health care usually provide standard care to most patients, which could lead to lower fidelity in the implementation of FIT64b.

Valuing biomarker diagnostics for dementia care: enhancing the reflection of patients, their care-givers and members of the wider public

What is the value of an early (presymptomatic) diagnosis of dementia in the absence of effective treatment? There has been a lively scholarly debate over this question, but until now (future) patients have not played a large role in it. Our study supplements biomedical research into innovative diagnostics with an exlporation of its meanings and values according to (future) patients. Based on seven focusgroups with (future) patients and their care-givers, we conclude that stakeholders evaluate early diagnostics with respect to whether and how they expect it to empower their capacity to (self-) care. They value it, for instance, with respect to whether it (a) explains experienced complaints, (b) allows to start a process of psychological acceptance and social adaptation to the expected degeneration, (c) contributes to dealing with anxieties (with respect to inheritable versions of dementia), (d) informs adequately about when to start preparing for the end of life, (d) informs the planning of a request for euthanasia, or (e) allows society to deal with a growing amount of dementia patients. Our study suggests that information about disease is considered 'harmful' or 'premature' when recipients feel unable to act on that information in their (self-) care. The results of this research offers input to further ethical research. It invites to adopt a care perspective in evaluation and to seek ways to prevent the 'harm' that such diagnostic methods can bring about.

Inclusive Decision Making for Falls Prevention: A Discussion Tool for Use With People With Dementia and Their Caregivers

Provision of choice and participation in falls prevention strategies is challenging for people with dementia. This study outlines development of a discussion tool to aid engagement of people with dementia and their caregivers in falls prevention strategies. The tool is based on a literature review of falls prevention and dementia care (1990-2016) and decision aid principles and was trialed over 6 months. A total of 25 community-dwelling people with dementia (M_age = 80 years, SD = 7.7, 52% male) and their caregivers (M_age = 73 years, SD = 12.3, 36% male) underwent falls risk assessment and evaluation of their preparedness to change falls risk behaviors. Most commonly rated, and prioritized for intervention, high falls risk factors were impaired balance/mobility (92%), polypharmacy (60%), and incontinence (56%). This discussion tool facilitated collaboration between people with dementia, their caregivers, and health professionals, to increase uptake of acceptable and feasible evidence-based falls prevention strategies.

Living With Dementia: A Meta-synthesis of Qualitative Research on the Lived Experience

Purpose of the Study

To identify and examine the published qualitative research evidence relative to the experience of living with dementia.

Design and Methods

Metasynthesis was used as the methodological framework to guide data collection and analysis.

Results

Three themes were identified. The first theme considered the main condition-related changes experienced by people with dementia (PWD) and showed how these are interlinked and impact upon various areas of people’s lives. The second theme indicated that amidst these changes, PWD strive to maintain continuity in their lives by employing various resources and coping strategies. The third theme underlined the role of contextual factors. The reviewed evidence indicates that, the emerging experience of PWD and their potential to adjust to the continuous changes is influenced by access to and quality of both personal and contextual resources which remain in a constant, transactional relationship to each other.

Implications

The findings were interpreted and discussed in the context of relevant theoretical frameworks and research evidence. It was considered that current evidence and findings presented in this review can be further explored and expanded upon in a more systematic way through research conducted within the theoretical framework of dynamic systems theory. Further research would be also beneficial to explore the subjective experience of dementia from a participatory perspective. Exploring the application of these theoretical standpoints would contribute to the current state of knowledge and offer both PWD and carers fresh perspective on the nature of change and potential for adaptability in dementia.

Experiences of advanced dementia care in seven European countries: implications for educating the workforce

Background: There is a paucity of robust research concerning the care experiences of peoplewith advanced dementia within Europe. It is essential to understand these experiences if weare to address care inequalities and create impactful dementia policies to improve servicesthat support individuals and enable family caring.

Objectives: To identify the strengths and weaknesses in daily life perceived by people with dementia and family caring across Europe by exemplifying experiences and the range of typical care settings for advanced dementia care in seven partner countries.

Methods: Twenty two in-depth qualitative case studies were completed in seven European countries across a range of care settings considered typical within that country. Narrative accounts of care illuminated a unique set of experiences and highlighted what was working well (strengths or positive aspects) and not so well (weaknesses or negative aspects) for people with advanced dementia and family caring. A constant comparative method of analysis through thematic synthesis was used to identify the common themes.

Results: Eight key themes were identified; Early diagnosis, good coordination between service providers, future planning, support and education for carers, enabling the person with dementia to live thebest life possible and education on advanced dementia for professional and family caregiverswere all significant and recurring issues considered important for care experiences to bepositive.

Conclusion: People with advanced dementia may have limited opportunities for self-realization and become increasingly reliant on the support of others to maximize their health and well-being. Careful attention must be given to their psychosocial well-being, living environment and family caring to enable them to live the best life possible. Building on what the case studies tell us about what works well, we discuss the potential for integrating the findings into interprofesional learning solutions for the professional workforce across Europe to champion practice-based change.

Epistemic injustice in dementia and autism patient organizations: An empirical analysis

Patient organizations (POs) represent patient collectives in health care policy. The inclusion of people with a 'neuro-psychiatric' condition poses a particular challenge for the organizational processes and political representation of such collectives. In recent years, new POs (POs of) have been established in the field of autism spectrum disorder and dementia that advocate a different agenda and have a different organizational structure than traditional POs (POs for). The divide between these two types of POs indicates a different standpoint with regard to who should be included on an organizational level, which voices are accepted and who should represent these voices on the political level. The inclusion and exclusion of voices needs to be normatively justified in order to be regarded legitimate representation of such a collective. With the help of Miranda Fricker's theory of epistemic injustice, we scrutinize whether and, if so, which types of epistemic injustices (wrongdoings to a person as a knower) can be found within POs' practices and the political field in which they operate, by analyzing 37 interviews with PO representatives, their members and policy makers. Our in-depth analysis indicates that persistent stereotypes hamper the inclusion of affected members both within POs and on the health political level. Being affected causes distrust in having the 'capacity to know' in a two-fold way; it is assumed that those who can represent themselves are "not affected enough" to present valuable insights into the condition and those who have difficulties to express themselves due to their condition are excluded because of their affectedness. We conclude that our analysis of the epistemic practices of POs serves as a good starting point to address these shortcomings from a theoretical and practical perspective and offers a valuable starting point for bioethics to understand unjust structures in the health political context.

Personhood, dementia policy and the Irish National Dementia Strategy

Personhood and its realisation in person-centred care is part of the narrative, if not always the reality, of care for people with dementia. This paper examines how personhood is conceptualised and actualised in Ireland through a content analysis of organisational and individual submissions from stakeholders in the development of the Irish National Dementia Strategy, followed by an examination of the Strategy itself. The organisational submissions are further categorised into dementia care models. A structural analysis of the Strategy examines its principles, actions and outcomes in relation to personhood. Of the 72 organisational and individual submissions received in the formulation of the Strategy, 61% contained references to personhood and its synonyms. Of the 35 organisational submissions, 40% fit a biomedical model, 31% a social model and 29% a biopsychosocial model. The Strategy contains one direct reference to personhood and 33 to personhood synonyms. Half of these references were contained within its key principles and objectives; none were associated with priority actions or outcomes. While stakeholders value personhood and the Strategy identifies personhood as an overarching principle, clearer direction on how personhood and person-centred care can be supported in practice and through regulation is necessary in Ireland. The challenge, therefore, is to provide the information, knowledge, incentives and resources for personhood to take hold in dementia care in Ireland.

The usual suspects: why techno-fixing dementia is flawed

Dementia is highly prevalent and up until now, still incurable. If we may believe the narrative that is currently dominant in dementia research, in the future we will not have to suffer from dementia anymore, as there will be a simple techno-fix solution. It is just a matter of time before we can solve the growing public health problem of dementia. In this paper we take a critical stance towards overly positive narratives of techno-fixes by placing our empirical analysis of dementia research protocols and political statements in a framework of technology assessment. From this perspective, it becomes obvious that a techno-fix is just one of many ways to approach societal problems and more importantly that technologies are way less perfect than they are presented. We will argue that this narrow scope, which focusses on the usual suspects for solving illnesses, reduces dementia to organismic aspects, and may be counterproductive in finding a cure for dementia. We conclude with outlining how the narrow scope can be balanced with other narratives and why we should have a reasonable scepticism towards the usual suspects.

Framing scandalous nursing home care: what is the problem?

The aim of this article is to investigate different ways in which nursing home scandals in Sweden have been framed, to discuss the relations between these existing frameworks, and to identify ways of describing the problem that are absent in the current debates. Data for the study consisted of media articles, television documentaries and internet debates, expert reports and court hearings, and interviews with representatives of organisations dealing with the issue of mistreatment in care services for older people. An analytical tool developed within social movement research was used to identify three ‘debates’ on such mistreatment in Sweden, where competing ways of framing the problem have been used: (a) a debate where staff are cast as either perpetrators or victims, (b) a debate on privatisation and profit as the motive for neglect of care recipients, and (c) a debate on deserving and non-deserving recipients of socially provided care centred around populist claims. The analysis highlights a need to introduce an alternative frame for interpretation where mistreatment in care for older people is regarded as involving scandalous cases of ageism. This anti-ageism frame would provide older people with a lead role in the drama – not just as victims but as stakeholders in relation to the problem.