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Kłosińska U, Ziółkowska J. Discourses of work life in narrative identities of people with advanced dementia. Int J Geriatr Psychiatry 2023; 38:e5921. [PMID: 37173832 DOI: 10.1002/gps.5921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES There is no consensus as to whether people with advanced dementia can create a narrative identity. It is most often thought to be disturbed due to autobiographical memory disorders. In this paper, we examined how people with advanced dementia constructed their narrative identities in relation to their professional experience. METHODS This qualitative study used data obtained from 8 semi-structured interviews. The interviewees were people with advanced dementia aged between 66 and 89 years. We analyzed the dataset based on the textual-oriented discourse analysis. RESULTS The study participants created narrative identities. Their narrative identities were constructed within residual professional discourses learned during their lifespan. These discourses blended their narrative identities into coherent stories about who they are now, offered languages to describe current experiences, and emphasized important values for their self-image. The participants built narrative identities by referring to the past and imagining a better present with the omission of the future. The past was valued positively and was a source of positive nostalgia. Projections of a better present served to reveal their needs and assess ways to meet them. CONCLUSIONS We argue that people with advanced dementia can create complex and coherent narrative identities. They are constructed around discourses and not only using autobiographical memories. Encouraging them to create narrative identities in the dialogue can be a simple therapeutic method by which they can maintain a sense of self-cohesion and belonging to the world.
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Affiliation(s)
- Urszula Kłosińska
- SWPS University of Social Sciences and Humanities, Faculty of Psychology, Wrocław, Poland
| | - Justyna Ziółkowska
- SWPS University of Social Sciences and Humanities, Faculty of Psychology, Wrocław, Poland
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Mentzou A, Sixsmith J, Ellis MP, Ross J. Change in the psychological self in people living with dementia: A scoping review. Clin Psychol Rev 2023; 101:102268. [PMID: 36898295 DOI: 10.1016/j.cpr.2023.102268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/02/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023]
Abstract
Alterations in one's sense of self are often considered a significant psychological symptom of dementia. However, the self is not a unified construct; it consists of a set of closely connected, yet substantive, manifestations which might not be equally impacted by dementia. Recognising the multidimensional nature of the self, the current scoping review aimed to explore the nature and scope of the evidence demonstrating change in the psychological self in people living with dementia. Adopting a cognitive psychological framework, a hundred and five (105) quantitative and qualitative studies were reviewed, and findings were organised into three main types of self-manifestations: high-order manifestations, functional aspects of the self, and foundational manifestations. Overall, the results show that although there are alterations in some of these different manifestations of the self, these do not imply a global loss of selfhood. Despite notable cognitive changes during dementia, it seems that preserved aspects of self may be enough to compensate for potential weakening of some self-processes such as autobiographical recall. Better understanding alterations in selfhood is key to addressing psychological symptoms of people living with dementia, such as feelings of disconnection and reduced agency, and may inform new pathways for dementia care interventions.
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Affiliation(s)
- Aikaterini Mentzou
- School of Humanities, Social Sciences and Law, Division of Psychology, University of Dundee, Scotland, UK.
| | - Judith Sixsmith
- School of Health Sciences, University of Dundee, Scotland, UK
| | - Maggie P Ellis
- School of Psychology and Neuroscience, University of St Andrews, Scotland, UK
| | - Josephine Ross
- School of Humanities, Social Sciences and Law, Division of Psychology, University of Dundee, Scotland, UK
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Intergenerational family relationships and the impact of behavioural variant frontotemporal dementia (bvFTD): a qualitative longitudinal study. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Research concerning the reciprocal influence of relationships and dementia largely focuses on dyadic relationships despite evidence that whole families are affected. Furthermore, such research generally considers more common forms of dementia such as Alzheimer's disease. Behavioural variant fronto-temporal dementia (bvFTD) primarily although not exclusively affects people below the age of 65 and is distinctly different in its impact from more common forms of dementia, affecting social cognition and therefore relational functioning. We aimed to develop a detailed understanding of intergenerational family experiences of bvFTD over time. We adopted a social constructivist and pluralist approach, using Narrative Thematic Analysis and Grounded Theory. We interviewed seven families in their own homes, including the person with bvFTD, at up to three time-points every six to nine months from 2012 to 2014, resulting in 46 interviews with 19 family members. Three super-ordinate themes were identified: Theme 1: We before bvFTD: cohesive and connected – disconnected and distant; Theme 2: Challenges experienced by us; and Theme 3: Relational outcomes: a changing we – an entrenched we. Results emphasise bvFTD brought early and significant disruption to family relationships. The interplay of prior relational functioning, involving the nature of the relationship for family members, the specific impact of bvFTD on these relationships and family member's understanding of bvFTD was critical to how each family fared over the duration of the research, and the relational outcomes they experienced. These findings suggest health-care practice could enhance its support for families living with bvFTD, through the development of tailored, family-oriented approaches to assessment and practice. Such approaches are necessary to understand how families work together and identify interventions that address the family-specific challenges bvFTD brings. The provision of tailored, relational-focused and specialised information concerning the experience of living with bvFTD is needed to flexibly address families' needs and expectations.
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Eriksen S, Grov EK, Ibsen TL, Mork Rokstad AM, Telenius EW. The experience of lived body as expressed by people with dementia: A systematic meta-synthesis. DEMENTIA 2022; 21:1771-1799. [PMID: 35437056 DOI: 10.1177/14713012221082369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION People with dementia undergo extensive bodily changes during the course of dementia. Even though this is largely unrecognised in the literature, these changes greatly impact on the persons' experiences of living with dementia. Consequently, health care professionals and family caregivers need to be aware of the implications this has for delivering care to people with dementia. Hence, a systematic review that synthesises the knowledge on this topic is called for. METHOD This article presents a qualitative systematic meta-synthesis of interview studies with people with dementia. The theoretical framework of lifeworlds by van Manen provided the context for the study. The Critical Appraisal Skills Program criteria for qualitative studies were used to appraise the studies. Thirty-nine qualitative research studies were included in the review. The analysis followed the principles of interpretive synthesis. FINDINGS When exploring people's experiences of their body when living with dementia, four categories emerge: (1) My body works; (2) My body betrays me; (3) Understanding and adapting to my body's changes; and (4) My body in relation to others. DISCUSSION/CONCLUSION Every individual has their own personal experience of living with dementia; however, if health professionals fail to regard the body as more than an object, this may lead to the person's alienation both from the relation and from the body. The lived body experience has relational aspects as people with dementia are aware that others observe them, and they also observe others. Others' behaviour may affect the person's experience of body; one can perceive oneself as approved or denounced. People with dementia describe that a body that is capable and strong gives access to the world and to participation.
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Affiliation(s)
- Siren Eriksen
- The Norwegian National Centre for Ageing and Health, 60512Vestfold Hospital Trust, Tønsberg, Norway / Lovisenberg Diaconal University College, Oslo, Norway
| | - Ellen K Grov
- Department of Nursing and Health Promotion, XXXOslo Metropolitan University, Oslo, Norway
| | - Tanja L Ibsen
- The Norwegian National Centre for Ageing and Health, 60499Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne M Mork Rokstad
- The Norwegian National Centre for Ageing and Health, XXXVestfold Hospital Trust, Tønsberg, Norway / Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Elisabeth W Telenius
- The Norwegian National Centre for Ageing and Health, XXXVestfold Hospital Trust, Tønsberg, Norway / VID Specialized University, Oslo, Norway
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Scott H. The changing self: The impact of dementia on the personal and social identity of women (findings from the Improving the Experience of Dementia and Enhancing Active Life programme). DEMENTIA 2021; 21:503-518. [PMID: 34636699 PMCID: PMC8811322 DOI: 10.1177/14713012211047351] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper explores the impact of dementia on the selfhood of women, specifically the ways in which changes occur as a result of such a diagnosis. Interviews were conducted with 12 women (recruited from the Improving the Experience of Dementia and Enhancing Active Life programme dataset), and analysed using interpretative phenomenological analysis. Emergent themes concerned the process of receiving and adjusting to a dementia diagnosis, the emotional and psychological impact of dementia, self-presentation and stigma and the self-enforcement of new boundaries. The analysis showed that dementia had a wide-ranging impact on the selfhood and identity of women, with newfound characteristics associated with the disease leading to a loss of self-esteem, sadness and anger. The women subsequently engaged in the modification of their behaviour, as a means of coming to terms with the losses experienced.
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Affiliation(s)
- Hannah Scott
- School of Clinical Medicine, 2152University of Cambridge, England
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Eriksen S, Bartlett RL, Grov EK, Ibsen TL, Telenius EW, Mork Rokstad AM. The Experience of Lived Time in People with Dementia: A Systematic Meta-Synthesis. Dement Geriatr Cogn Disord 2020; 49:435-455. [PMID: 33176312 PMCID: PMC7949212 DOI: 10.1159/000511225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/27/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION For people with dementia, lived time is important to understand, as the condition affects memory, perceptions of time, and life expectancy. The aim of this study was to locate, interpret, and synthesize the experience of lived time for people with dementia. METHOD This article presents a qualitative systematic meta-synthesis. The theoretical framework of lifeworlds by van Manen provided the context for the study. The Critical Appraisal Skills Programme criteria for qualitative studies were used to appraise the studies. Sixty-one qualitative research studies based on interviews with people with dementia were included in the review. The analysis followed the principles of interpretive synthesis. RESULTS Four categories were revealed: (1) rooted in the past - "I am the same as before"; (2) focussing on the present - "Nobody has tomorrow"; (3) thinking about the future - "What is going to happen to me?"; and (4) changes in the experience of self over time - "I used to…." The latent overall meaning was expressed as "being engaged with the dimensions of time." DISCUSSION/CONCLUSION The experience of lived time is an active and important one, enabling people to manage the dementia journey. Future work involving people with dementia should foreground the experience of lived time.
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Affiliation(s)
- Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Ruth Louise Bartlett
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Tanja Louise Ibsen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Elisabeth Wiken Telenius
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne Marie Mork Rokstad
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway,
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Arroyo-Anlló EM, Sánchez JC, Gil R. Could Self-Consciousness Be Enhanced in Alzheimer’s Disease? An Approach from Emotional Sensorial Stimulation. J Alzheimers Dis 2020; 77:505-521. [DOI: 10.3233/jad-200408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Alzheimer’s disease (AD) provides a valuable field of research into impairment of self-consciousness (SC), because AD patients have a reduced capacity to understand their mental world, to experience and relive previous personal events, as well as to interpret thoughts, feelings, and beliefs about themselves. Several studies observed that AD patients had an altered SC, but not a complete abolition of it. Emotions are an integral part of the construction of personal identity, therefore of Self. In general, most studies on emotion in AD patients have observed that emotion is not completely abolished and it lets them better remember autobiographical events with greater emotional charge. The positive effect of autobiographical memories rich in emotional content, evoked directly/automatically by sensorial stimuli such as familiar odors or music, could be used to reestablish/reinforce the permanence and coherence of the Self in AD. We studied the research of empirical evidence supporting the power of the sensorial cues associated with emotion, which could be capable of enhancing the SC in AD. We presented the studies about “Emotional stimulations” using odor, music, or taste cues in AD. All studies have shown to have a positive impact on SC in AD patients such as odor-evoked autobiographical memories, taste/odor-evoked autobiographical memories, emotional sensorial stimulation using musical cues, and multi-sensorial stimulations using healing gardens. We found research supporting the notion that emotional sensorial stimulations can even temporarily exalt memory, affective state, and personal identity, that is, the SC in AD. The emotional sensory stimulations could be used as a tool to activate the SC in AD and hence improve the quality of life of patients and caregivers.
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Affiliation(s)
- Eva M. Arroyo-Anlló
- Department of Psychobiology, University of Salamanca, Neuroscience Institute of Castilla-León, Spain
| | | | - Roger Gil
- Emeriti Professor of Neurology, University Hospital, Poitiers, France
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Mmako NJ, Courtney-Pratt H, Marsh P. Green spaces, dementia and a meaningful life in the community: A mixed studies review. Health Place 2020; 63:102344. [PMID: 32543430 DOI: 10.1016/j.healthplace.2020.102344] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 11/15/2022]
Abstract
Engagement in green spaces impacts positively on wellbeing and quality of life. However, little is known about the impacts of green space engagement specifically for people living with the experience of dementia in the community; people with a heightened need to maintain a quality life. In this mixed study review, we explore existing evidence for quality of life impacts of contact with green spaces by people living with dementia in the community. Findings show that gardens and horticultural programs, green care farms, parks, urban woodlands and neighbourhood outdoor environments can impact positively in several ways. Four key mechanisms are identified: Engaging in meaningful activities; Empowerment; Positive risk taking; and Reinforcing Identity. These findings provide conceptual links between psychosocial understandings of the relationships between nature and wellbeing with rights-based dementia discourses. We conclude that evidence specific for people living with dementia in the community setting is growing and there is potential for green spaces to enable an active and meaningful community-life, despite cognitive decline. This is worthy of consideration by policy makers, practitioners and carers. Future studies can broaden this field of research and include investigations into lesser-explored aspects of quality of life, such as spirituality, and methods that incorporate the voices of people living with dementia.
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Affiliation(s)
- Nkolika Janet Mmako
- Wicking Dementia Research & Education Centre, University of Tasmania, Private Bag 143, Hobart, Tasmania, 7001, Australia.
| | - Helen Courtney-Pratt
- Wicking Dementia Research and Education Centre, University of Tasmania, Private Bag 143, Hobart, 7001, Australia.
| | - Pauline Marsh
- Centre for Rural Health, University of Tasmania, Private Bag 103, Hobart, Tasmania, 7001, Australia.
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Frewen P, Schroeter ML, Riva G, Cipresso P, Fairfield B, Padulo C, Kemp AH, Palaniyappan L, Owolabi M, Kusi-Mensah K, Polyakova M, Fehertoi N, D’Andrea W, Lowe L, Northoff G. Neuroimaging the consciousness of self: Review, and conceptual-methodological framework. Neurosci Biobehav Rev 2020; 112:164-212. [DOI: 10.1016/j.neubiorev.2020.01.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 01/06/2020] [Accepted: 01/20/2020] [Indexed: 01/04/2023]
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Birt L, Griffiths R, Charlesworth G, Higgs P, Orrell M, Leung P, Poland F. Maintaining Social Connections in Dementia: A Qualitative Synthesis. QUALITATIVE HEALTH RESEARCH 2020; 30:23-42. [PMID: 31550999 DOI: 10.1177/1049732319874782] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The clinical symptoms of dementia include difficulty with speech, poor short-term memory, and changes in behavior. These symptoms can affect how the person with dementia understands and performs in social interactions. This qualitative review investigated how people with mild to moderate dementia managed social connections. A systematic search of social science databases retrieved 13 articles; data were synthesized using thematic analysis. Results established the work undertaken by people with dementia to maintain and present a social persona seen as socially acceptable. Interpretations are contextualized within Goffman and Sabat's theories on "self." People with dementia were agentic in impression management: undertaking work to maintain recognized social roles, while being aware of when their illness led to others discrediting them. Wider recognition of strategies used to maintain a social self could inform interventions designed to increase capability and confidence in co-managing social connections following dementia diagnosis.
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Affiliation(s)
- Linda Birt
- University of East Anglia, Norwich, United Kingdom
| | | | - Georgina Charlesworth
- University College London, London, United Kingdom
- North East London NHS Foundation Trust, London, United Kingdom
| | - Paul Higgs
- University College London, London, United Kingdom
| | - Martin Orrell
- University of Nottingham, Nottingham, United Kingdom
| | - Phuong Leung
- University College London, London, United Kingdom
| | - Fiona Poland
- University of East Anglia, Norwich, United Kingdom
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Creating conditions for a sense of security during the evenings and nights among older persons receiving home health care in ordinary housing: a participatory appreciative action and reflection study. BMC Geriatr 2019; 19:351. [PMID: 31842776 PMCID: PMC6915921 DOI: 10.1186/s12877-019-1372-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today many older persons in ordinary housing receive home health care. It is stipulated that the care is to provide security; however, deficiencies in home health care are reported in many countries. It may be difficult to implement a sense of security among older persons receiving home health care in ordinary housing, especially during the evenings and nights, due to a lack of knowledge. METHODS This study is part of a larger project with a participatory appreciative action and reflection (PAAR) approach. We invited older persons, relatives, nurse assistants, registered nurses, and their managers to co-create knowledge with us on how conditions for a sense of security can be created during evenings and nights among older persons receiving home health care in ordinary housing. We performed thematic analysis of the data. RESULTS Five subthemes were developed that gave structure to two main themes. The first main theme, To confirm the self-image, has the following subthemes: To see the home as a reflection of the person's identity and To maintain self-determination. The second main theme, To create interaction in a sheltered place, has these subthemes: To undress the power, To create control and lifelines, and To create a good sleeping environment. The two themes interact and are each other's conditions. The person's self-image must be confirmed in order to create interaction in a sheltered place and through the interaction, the self-image is confirmed. CONCLUSION Conditions necessary for older persons to have a sense of security are living in a familiar environment, having habits and routines maintained, and having self-determination. Other conditions are equality, the prevention of falls, and an individualized sleeping environment. Older people's self-determination should be honored, and they should not being excluded from decision-making. We need to ask them if the conditions are sufficient and their sense of security is great enough to allow them to continue living in their ordinary housing.
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Bjørkløf GH, Helvik AS, Ibsen TL, Telenius EW, Grov EK, Eriksen S. Balancing the struggle to live with dementia: a systematic meta-synthesis of coping. BMC Geriatr 2019; 19:295. [PMID: 31666020 PMCID: PMC6822397 DOI: 10.1186/s12877-019-1306-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 10/07/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND People with dementia describe experiences of loss that threaten their autonomy and ability to contribute to society. They often have difficulties with orientation, loss of roll function, and fear about the future, and need help from others. An increasing body of literature also focuses on how people with dementia search for meaning and maintaining of quality to life, and how they find strategies to live with dementia. A review of the scientific literature on coping and dementia is warranted and can help to advice and inform healthcare personnel and decision makers on how they can support and plan for appropriate healthcare services for people with dementia. The aim of this systematic meta-synthesis was therefore to interpret and synthesize knowledge regarding people with dementia's experience of coping. METHODS We conducted a systematic, computerised search of Medline, Embase, Cinahl Complete, PsycINFO and Age Line combining MeSH terms and text words for different types of dementia with different descriptions of experience. Studies comprised 1) a sample of people with dementia, 2) a qualitative interview as a research method and 3) a description of experiences of coping were included. The search resulted in 7129 articles, of which 163 were read in full text, 80 were excluded due to the exclusion criteria or low quality according. The analysis was conducted in line with qualitative content analyses. RESULTS This interpretative qualitative meta-synthesis included 74 articles of good quality encompassing interviews with 955 persons with dementia. The material revealed two main resources of coping: (1) Humour and (2) Practical and emotional support, and four overall strategies in which people with dementia cope with the challenges they experience: (1) Keep going and holding on to life as usual; (2) Adapting and adjusting to the demands from the situation; (3) Accepting the situation; and (4) Avoiding the situation A comprehensive understanding of the categories led to the latent theme: Balancing the struggle of living with dementia. CONCLUSION This meta-synthesis indicates that people with dementia cope in different ways and using several parallel strategies. This insight is essential in dementia care to facilitate a supportive environment.
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Affiliation(s)
- Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Postbox 2136, N-3103 Tønsberg, Norway
| | - Anne-Sofie Helvik
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Postbox 2136, N-3103 Tønsberg, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tanja Louise Ibsen
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Postbox 2136, N-3103 Tønsberg, Norway
| | - Elisabeth Wiken Telenius
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Postbox 2136, N-3103 Tønsberg, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Postbox 2136, N-3103 Tønsberg, Norway
- VID Spesialized University, Faculty of Health Studies, Oslo, Norway
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Nordgren L, Asp M. Photo-Elicited Conversations about Therapy Dogs as a Tool for Engagement and Communication in Dementia Care: A Case Study. Animals (Basel) 2019; 9:ani9100820. [PMID: 31627391 PMCID: PMC6826407 DOI: 10.3390/ani9100820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/09/2019] [Accepted: 10/14/2019] [Indexed: 11/16/2022] Open
Abstract
Understanding the inner life of people with dementia can be challenging and there is a need for new and different approaches. Previous research shows that people with dementia can experience emotions such as harmony, closeness, and joy as well as sadness and concern when interacting with a therapy dog. Simultaneously, memories of past episodes are brought back to life when the person interacts with the dog. This raises questions about whether photos of interaction with a dog can evoke memories or support people with dementia in communicating emotions in a corresponding way. The aim of this study was to explore photo-elicited conversations as a tool for engagement and communication in dementia care. Repeated video observations of photo-elicited conversations between a woman with dementia and a dog handler/assistant nurse were used to collect data. The video recordings were analyzed with a phenomenological hermeneutical method. The role of photo-elicited conversations as a tool for engagement and communication in dementia care is that the conversations can help the person with dementia to feel a sense of being situated and recall feelings of liveliness and belongingness, and thus supporting the person's sense of self. The results can be used to deepen nursing staff's understanding of using photo-elicited conversations in dementia care.
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Affiliation(s)
- Lena Nordgren
- Centre for Clinical Research Sörmland, Uppsala University, 631 88 Eskilstuna, Sweden.
- Department of Public Health and Caring Sciences, Uppsala University, 752 36 Uppsala, Sweden.
| | - Margareta Asp
- School of Health, Care and Social Welfare, Mälardalen University, 722 20 Västerås, Sweden.
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Larsson V, Holmbom-Larsen A, Torisson G, Strandberg EL, Londos E. Living with dementia with Lewy bodies: an interpretative phenomenological analysis. BMJ Open 2019; 9:e024983. [PMID: 30700486 PMCID: PMC6352787 DOI: 10.1136/bmjopen-2018-024983] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To explore the subjective experience of living with dementia with Lewy bodies (DLB). DESIGN A qualitative study of in-depth interviews using interpretative phenomenological analysis. SETTING A memory clinic in Malmö, southern Sweden. PARTICIPANTS A purposive sample of five male participants with DLB between the ages of 78 and 88 years and disease duration of 1.5-7 years. RESULTS Three themes were identified in relation to the participants' experiences of living with DLB: (1) disease impact, in terms of symptom experience and restricted participation and activities; (2) self-perception and coping strategies; (3) importance of others, such as healthcare, family and friends. CONCLUSIONS This study provides a broad insight into the first-hand experience of living with DLB and how it compares with other dementia types. Findings highlight factors characterising the disease experience and well-being, and how persons with DLB address challenges arising secondary to disease. These findings are important for both research and clinical practice, demonstrating the feasibility of direct involvement of DLB persons in identifying important aspects of care, which include improved healthcare services.
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Affiliation(s)
- Victoria Larsson
- Department of Clinical Sciences, Malmö, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Axel Holmbom-Larsen
- Department of Clinical Sciences, Malmö, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Gustav Torisson
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | - Eva Lena Strandberg
- Department of Clinical Sciences, Malmö, Center for Primary Health Care Research, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Elisabet Londos
- Department of Clinical Sciences, Malmö, Clinical Memory Research Unit, Lund University, Malmö, Sweden
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Through the eyes of others - the social experiences of people with dementia: a systematic literature review and synthesis. Int Psychogeriatr 2018; 30:791-805. [PMID: 29970210 DOI: 10.1017/s1041610216002374] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:Psychosocial models suggest that the lived experience of dementia is affected by interpersonal factors such as the ways in which others view, talk about, and behave toward the person with dementia. This review aimed to illuminate how informal, everyday interpersonal relationships are experienced by people with dementia within their social contexts. METHOD A systematic review of qualitative literature published between 1989 and May 2016 was conducted, utilizing the electronic databases PsycINFO, MEDLINE, and CINAHL-Complete. This was followed by a critical interpretative synthesis to understand how people with dementia perceive the attitudes, views, and reactions of other people toward them, and the subjective impact that these have. RESULTS Four major themes were derived from the findings of the 23 included studies: being treated as an "other" rather than "one of us"; being treated as "lesser" rather than a full, valued member of society; the impact of others' responses; and strategies to manage the responses of others. Thus, people with dementia can feel outcast and relegated, or indeed feel included and valued by others. These experiences impact upon emotional and psychological well-being, and are actively interpreted and managed by people with dementia. CONCLUSION Experiences such as loss and diminishing identity have previously been understood as a direct result of dementia, with little consideration of interpersonal influences. This review notes that people with dementia actively engage with others, whose responses can foster or undermine social well-being. This dynamic relational aspect may contribute to emerging understandings of social health in dementia.
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Swall A, Ebbeskog B, Lundh Hagelin C, Fagerberg I. Stepping out of the shadows of Alzheimer's disease: a phenomenological hermeneutic study of older people with Alzheimer's disease caring for a therapy dog. Int J Qual Stud Health Well-being 2018; 12:1347013. [PMID: 28699394 PMCID: PMC5510223 DOI: 10.1080/17482631.2017.1347013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: Living with Alzheimer’s disease (AD) can involve a person being unable to recall and convey information in daily life. There are several ways to provide person-centred care to older people with AD, e.g. by empowering them in a situation. The use of animal-assisted therapy (AAT) with a therapy dog in the care of people with dementia is increasing, with the presence of a therapy dog being described as improving, among other things, the well-being and socialization of the person. The aim of this study was to illuminate meanings of care for people with AD in their encounters with a therapy dog. Method: The study used video-recorded observations of the person with AD and the dog. Data were transcribed and analysed using a phenomenological hermeneutic method. Results: The main theme was “Using one’s own resources and abilities as a human being”, which meant being the person one can be and distancing oneself from the symptoms of AD during the time with the dog. Conclusions: The feelings evoked in the people with AD included empathy and altruism, which allowed for a sense of joy and tenderness, which may induce a sense of self-worth, of being needed, and of being meaningful.
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Affiliation(s)
- Anna Swall
- a Department of Health Sciences, School of Health and Social Studies , Dalarna University , Falun , Sweden
| | - Britt Ebbeskog
- b Karolinska Institutet, Department of Neurobiology , Care Science and Society , Stockholm , Sweden
| | - Carina Lundh Hagelin
- b Karolinska Institutet, Department of Neurobiology , Care Science and Society , Stockholm , Sweden.,c Sophiahemmet University , Department of Nursing Science , Stockholm , Sweden
| | - Ingegerd Fagerberg
- d Department of Health Care Science , Ersta Sköndal Bräcke University College , Stockholm , Sweden
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Viaña JNM, Gilbert F. Deep brain stimulation for people with Alzheimer's disease: Anticipating potential effects on the tripartite self. DEMENTIA 2018. [PMID: 29528701 DOI: 10.1177/1471301218761147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Memory dysfunction and cognitive impairments due to Alzheimer’s disease can affect the selfhood and identity of afflicted individuals, causing distress to both people with Alzheimer’s disease and their caregivers. Recently, a number of case studies and clinical trials have been conducted to determine the potential of deep brain stimulation as a therapeutic modality for people with Alzheimer’s disease. Some of these studies have shown that deep brain stimulation could induce flashbacks and stabilize or even improve memory. However, deep brain stimulation itself has also been attributed as a potential threat to identity and selfhood, especially when procedure-related adverse events arise. We anticipate potential effects of deep brain stimulation for people with Alzheimer’s disease on selfhood, reconciling information from medical reports, psychological, and sociological investigations on the impacts of deep brain stimulation or Alzheimer’s disease on selfhood. A tripartite model of the self that extends the scope of Rom Harré’s and Steve Sabat’s social constructionist framework was used. In this model, potential effects of deep brain stimulation for Alzheimer’s disease on Self 1 or singularity through use of first-person indexicals, and gestures of self-reference, attribution, and recognition; Self 2 or past and present attributes, knowledge of these characteristics, and continuity of narrative identity; and Self 3 or the relational and social self are explored. The ethical implications of potential effects of deep brain stimulation for Alzheimer’s disease on the tripartite self are then highlighted, focusing on adapting informed consent procedures and care provided throughout the trial to account for both positive and negative plausible effects on Self 1, Self 2, and Self 3.
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Affiliation(s)
- John Noel M Viaña
- Wicking Dementia Research and Education Centre, College of Health and Medicine; Ethics, Policy and Public Engagement Program, Australian Research Council Centre of Excellence for Electromaterials Science; Philosophy and Gender Studies Program, School of Humanities, College of Arts, Law, and Education, University of Tasmania, Hobart, Australia
| | - Frederic Gilbert
- Center for Sensorimotor Neural Engineering and Department of Philosophy, University of Washington, Seattle, WA, USA; Ethics, Policy and Public Engagement Program, Australian Research Council Centre of Excellence for Electromaterials Science, University of Tasmania, Hobart, Australia
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Sikes P, Hall M. "It was then that I thought 'whaat? This is not my Dad": The implications of the 'still the same person' narrative for children and young people who have a parent with dementia. DEMENTIA 2018; 17:180-198. [PMID: 26951362 PMCID: PMC5802543 DOI: 10.1177/1471301216637204] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This research used auto/biographical interviews to explore the experiences of 19, 8 to 31 year olds who had a parent with dementia. Thematic analysis revealed challenges occasioned by the master narrative that people with dementia are 'still' the same person they were prior to the onset of their condition. While this notion is - rightly - at the heart of person-centered care in dementia services, the 'still' discourse conflicts with the experiences of young people. Their accounts suggest that the construction of their parent as the same person is not helpful and that, furthermore, expectations that they will behave and feel towards that parent as they did before are a source of distress in what is already a challenging situation. This paper highlights the need to equip young people with support that acknowledges that their parent may well be drastically different to the Mum or Dad they previously 'knew'.
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Affiliation(s)
- Pat Sikes
- School of Education, University of Sheffield, UK
| | - Mel Hall
- School of Education, University of Sheffield, UK
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Førsund LH, Grov EK, Helvik AS, Juvet LK, Skovdahl K, Eriksen S. The experience of lived space in persons with dementia: a systematic meta-synthesis. BMC Geriatr 2018; 18:33. [PMID: 29390970 PMCID: PMC5795848 DOI: 10.1186/s12877-018-0728-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying how persons with dementia experience lived space is important for enabling supportive living environments and creating communities that compensate for the fading capabilities of these persons. Several single studies have explored this topic; however, few studies have attempted to explicitly review and synthesize this research literature. The aim of this systematic meta-synthesis was therefore to interpret and synthesize knowledge regarding persons with dementia's experience of space. METHODS A systematic, computerized search of AgeLine, CINAHL Complete, Embase, Medline and PsycINFO was conducted using a search strategy that combined MeSH terms and text words for different types of dementia with different descriptions of experience. Studies with 1) a sample of persons with dementia, 2) qualitative interviews as a research method and 3) a description of experiences of lived space were included. The search resulted in 1386 articles, of which 136 were identified as eligible and were read and assessed using the CASP criteria. The analysis was inspired by qualitative content analyses. RESULTS This interpretative qualitative meta-synthesis included 45 articles encompassing interviews with 672 persons with dementia. The analysis showed that living in one's own home and living in long-term care established different settings and posed diverse challenges for the experience of lived space in persons with dementia. The material revealed four main categories that described the experience of lived space: (1) belonging; (2) meaningfulness; (3) safety and security; and (4) autonomy. It showed how persons with dementia experienced a reduction in their lived space due to the progression of dementia. A comprehensive understanding of the categories led to the latent theme: "Living with dementia is like living in a space where the walls keep closing in". CONCLUSION This meta-synthesis reveals a process whereby lived space gradually becomes smaller for persons with dementia. This underscores the importance of being aware of the experiences of persons with dementia and the spatial dimensions of their life-world. To sustain person-centred care and support the preservation of continuity and identity, one must acknowledge not only the physical and social environment but also space as an existential experience for persons with dementia.
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Affiliation(s)
- Linn Hege Førsund
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University College of Southeast Norway, Postbox 7053, N- 3007 Drammen, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anne-Sofie Helvik
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lene Kristine Juvet
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University College of Southeast Norway, Postbox 7053, N- 3007 Drammen, Norway
- The National Institute of Public Health, Oslo, Norway
| | - Kirsti Skovdahl
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University College of Southeast Norway, Postbox 7053, N- 3007 Drammen, Norway
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
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Eriksen S, Helvik AS, Juvet LK, Skovdahl K, Førsund LH, Grov EK. The Experience of Relations in Persons with Dementia: A Systematic Meta-Synthesis. Dement Geriatr Cogn Disord 2018; 42:342-368. [PMID: 27866199 DOI: 10.1159/000452404] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dementia influences a person's experience of social relationships, as described in several studies. In this systematic meta-synthesis of qualitative studies, we aim to interpret and synthesize the experiences of persons with dementias and their relations with others. SUMMARY Living with dementia changes life, leading to new social roles and different social statuses. Persons with dementia experience being disconnected and dependent on others, feeling like being a burden, and being a person who is treated in paternalistic ways. Family, friends and others with dementia might play significant roles in their ability to maintain a meaningful life. Key Messages: Three categories emerged from the data, change in life, change in relations, and maintenance of meaningful aspects in life; these categories are intertwined and essential in sustaining a lifeline for persons with dementia. The comprehensive meaning of the material is understood as the expression: Living a meaningful life in relational changes.
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Affiliation(s)
- Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
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Cronfalk BS, Norberg A, Ternestedt BM. They are still the same - family members’ stories about their relatives with dementia disorders as residents in a nursing home. Scand J Caring Sci 2017; 32:168-176. [DOI: 10.1111/scs.12442] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 01/11/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Berit Seiger Cronfalk
- Department of Nursing Sciences and Palliative Research Centre; Ersta Sköndal University College; Stockholm Sweden
- Department of Nursing; Stord Haugesund University College; Haugesund Norway
- Department of Neurobiology, Care sciences and Society; Karolinska Institute; Stockholm Sweden
| | - Astrid Norberg
- Department of Nursing Sciences and Palliative Research Centre; Ersta Sköndal University College; Stockholm Sweden
- Department of Nursing; Umeå University; Umeå Sweden
| | - Britt-Marie Ternestedt
- Department of Nursing Sciences and Palliative Research Centre; Ersta Sköndal University College; Stockholm Sweden
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Hedman R, Norberg A, Hellström I. Agency and Communion in People with Alzheimer’s Disease, as Described by Themselves and their Spousal Carers. DEMENTIA 2017; 18:1354-1372. [DOI: 10.1177/1471301217706268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Agency (individuality) and communion (togetherness) are vital to a positive sense of self. People with Alzheimer’s disease are at risk of experiencing diminished agency and decreased communion. Their family members’, especially their partner’s, view on their agency and communion is also likely to influence their sense of agency, communion, and self. In the present study, individual interviews with 10 people with Alzheimer’s disease and their spousal carers were qualitatively analysed to describe how in each couple the two spouses viewed the agency and communion of the person with Alzheimer’s disease from an individual perspective. The findings show that the carers generally described the agency of the person with Alzheimer’s disease as slightly weaker compared with the persons with Alzheimer’s disease themselves. The carers also appeared to have poor knowledge of what supported and threatened the sense of communion of the person with Alzheimer’s disease.
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Affiliation(s)
- Ragnhild Hedman
- Department of Health Care Sciences, Ersta Sköndal Bräcke University, Sweden; The Palliative Research Centre, Ersta Sköndal University College, Sweden
| | - Astrid Norberg
- Department of Health Care Sciences, Ersta Sköndal Bräcke University, Sweden; The Palliative Research Centre, Ersta Sköndal University College, Sweden; Department of Nursing, Umeå University, Sweden
| | - Ingrid Hellström
- Department of Health Care Sciences, Ersta Sköndal Bräcke University, Sweden; The Palliative Research Centre, Ersta Sköndal University College, Sweden; CEDER, Department of Social and Welfare Studies, Linköping University, Sweden
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Hedman R, Hellström I, Ternestedt BM, Hansebo G, Norberg A. Sense of Self in Alzheimer’s Research Participants. Clin Nurs Res 2016; 27:191-212. [DOI: 10.1177/1054773816672671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The sense of self is vulnerable in people with Alzheimer’s disease (AD), and might be positively and negatively influenced by research participation. The purpose of this study was to describe how people with AD express their experience of being a research participant with respect to their sense of self. Interviews and support group conversations involving 13 people with mild and moderate AD were analyzed using qualitative content analysis. Three themes were constructed: contributing to an important cause, gaining from participating, and experiencing risks and drawbacks. Participants described contributing to research as being in line with their lifelong values and lifestyles. They expressed contentment and pride about being research participants, emphasized their positive relationships with the researchers, and described participation as a meaningful activity. When research procedures threatened their sense of self, they were able to reason about risks and decline participation.
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Affiliation(s)
- Ragnhild Hedman
- Karolinska Institutet, Stockholm, Sweden
- Ersta Sköndal University College, Stockholm, Sweden
| | - Ingrid Hellström
- Ersta Sköndal University College, Stockholm, Sweden
- Linköping University, Sweden
| | - Britt-Marie Ternestedt
- Karolinska Institutet, Stockholm, Sweden
- Ersta Sköndal University College, Stockholm, Sweden
| | - Görel Hansebo
- Karolinska Institutet, Stockholm, Sweden
- Ersta Sköndal University College, Stockholm, Sweden
| | - Astrid Norberg
- Ersta Sköndal University College, Stockholm, Sweden
- Umeå University, Sweden
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Cedervall Y, Torres S, Åberg AC. Maintaining well-being and selfhood through physical activity: experiences of people with mild Alzheimer's disease. Aging Ment Health 2016; 19:679-88. [PMID: 25265932 DOI: 10.1080/13607863.2014.962004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To contribute to furthering the understanding of how people with mild Alzheimer's disease (AD) reason about physical activity as part of everyday life, with a specific focus on the meanings attached to such activity. METHOD In-depth interviews were conducted with 14 individuals with mild AD. Qualitative content analysis was used to interpret the data. RESULTS The analysis revealed three sub-themes reflecting interrelated perspectives on how people with mild AD reason about physical activity: (1) striving to be physically active, mirrors the concrete approaches used for handling the consequences of having AD in relation to being active; (2) perceptions of physical activity, reflect how their thoughts and beliefs regarding written and tacit norms encouraged them to remain physically active, and (3) physical activity as a means to well-being, alludes to feelings and emotions related to the performance of physical activity. Interpretation of the underlying patterns in these sub-themes revealed one overarching theme: Physical activity as a means to selfhood maintenance, which suggests that physical activity can help to shift the focus from the dementia diagnosis (i.e. ill health) to a more healthy and able self. CONCLUSION The findings suggest that physical activity, apart from maintaining body functions, can be a way to sustain well-being and selfhood in mild AD. This aspect of physical activity is important to consider in research, policy and practice when addressing the needs of people with dementia.
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Affiliation(s)
- Ylva Cedervall
- a Department of Public Health and Caring Sciences/Geriatrics , Uppsala University , Uppsala , Sweden
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25
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Smebye KL, Kirkevold M, Engedal K. Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study. BMC Health Serv Res 2016; 16:21. [PMID: 26787190 PMCID: PMC4717656 DOI: 10.1186/s12913-015-1217-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 12/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for people with dementia living in their own homes is a challenging care issue that raises ethical dilemmas of how to balance autonomy with their safety and well-being. The theoretical framework for this study consisted of the concepts of autonomy, beneficence, non-maleficence, paternalism and from the ethics of care. The aim of this study was to explore ethical dilemmas concerning autonomy that were identified when persons with dementia wished to live at home. METHODS This Norwegian study had a qualitative, hermeneutic design and was based on nine cases. Each case consisted of of a triad: the person with dementia, the family carer and the professional caregiver. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2 i.e. dementia of moderate degree (4) able to communicate verbally and (5) expressed a wish to live at home. The family carers and professional caregivers registered in the patients' records were included in the study. An interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day care centre. By means of deductive analysis, autonomy-related ethical dilemmas were identified. The final interpretation was based on perspectives from the theoretical framework. RESULTS The analysis revealed three main ethical dilemmas: When the autonomy of the person with dementia conflicted with (1) the family carer's and professional caregiver's need to prevent harm (non-maleficence) (2) the beneficence of family carers and professional caregivers (3) the autonomy of the family carer. CONCLUSIONS In order to remain living in their own homes, people with dementia accepted their dependence on others in order to uphold their actual autonomy and live in accordance with their identified values. Paternalism could be justified in light of beneficence and non-maleficence and within an ethics of care.
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Affiliation(s)
| | - Marit Kirkevold
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Blindern, P.B. 1130, 0318 Oslo, Norway
- Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Knut Engedal
- Norwegian Centre for Aging and Health, Vestfold Health Trust, 3130 Tønsberg, Norway
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Skaalvik MW, Fjelltun AMS, Normann HK, Norberg A. Expressions of Sense of Self Among Individuals With Alzheimer’s Disease. Res Theory Nurs Pract 2016; 30:161-75. [DOI: 10.1891/1541-6577.30.2.161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent research has challenged the previously held view that people with Alzheimer’s disease (AD) lack a sense of self, with several studies demonstrating that the sense of self is partially preserved, even in late stages of AD. The aim of this study was to examine how people with AD express their sense of self (Self 1–3) using the social constructionist theory of selfhood described by Harré (1998). Personal interviews were analyzed deductively. The participants narrated fragments of their life stories and expressed the fear of becoming a burden to family members and of nursing home placement. They expressed Self 1 (personal singularity or personal identity) without any problems, whereas their Self 2 (self-concept) attributes had undergone changes that they had learned to live with. The participants expressed surprisingly few problems with their narratives of Self 3 (social personae), that is, their accounts of interactions with other people. They reported being received positively when they were open about their diagnosis. These results provide further nuances that broaden our understanding of the process of preserving the sense of self, that is, simultaneously being the same and a different person.
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Söderlund M, Cronqvist A, Norberg A, Ternestedt BM, Hansebo G. Conversations between persons with dementia disease living in nursing homes and nurses - qualitative evaluation of an intervention with the validation method. Scand J Caring Sci 2015; 30:37-47. [DOI: 10.1111/scs.12219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 01/03/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Mona Söderlund
- Department of Health Care Sciences; Ersta Sköndal University College; Stockholm Sweden
| | - Agneta Cronqvist
- Department of Health Care Sciences; Ersta Sköndal University College; Stockholm Sweden
| | - Astrid Norberg
- Department of Health Care Sciences; Ersta Sköndal University College; Stockholm Sweden
- Palliative Research Centre; Ersta Sköndal University College & Ersta Hospital; Stockholm Sweden
- Department of Nursing; Umeå University; Umeå Sweden
| | - Britt-Marie Ternestedt
- Department of Health Care Sciences; Ersta Sköndal University College; Stockholm Sweden
- Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
- Palliative Research Centre; Ersta Sköndal University College & Ersta Hospital; Stockholm Sweden
- Research and Development Department; Stockholm Sjukhem Foundation; Stockholm Sweden
| | - Görel Hansebo
- Department of Health Care Sciences; Ersta Sköndal University College; Stockholm Sweden
- Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
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McEvoy P, Plant R. Dementia care: using empathic curiosity to establish the common ground that is necessary for meaningful communication. J Psychiatr Ment Health Nurs 2014; 21:477-82. [PMID: 24654828 DOI: 10.1111/jpm.12148] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2014] [Indexed: 01/10/2023]
Abstract
Over the past two decades the advocates of person-centred approaches to dementia care have consistently argued that some of the negative impacts of dementia can be ameliorated in supportive social environments and they have given lie to the common but unfounded, nihilistic belief that meaningful engagement with people with dementia is impossible. This discussion paper contributes to this welcome trend by exploring how carers can use empathic curiosity to establish the common ground that is necessary to sustain meaningful engagement with people who have mild to moderate dementia. The first section of the paper gives a brief theoretical introduction to the concept of empathic curiosity, which is informed by perceptual control theory and applied linguistics. Three case examples taken from the literature on dementia care are then used to illustrate what empathic curiosity may look like in practice and to explore the potential impact that adopting an empathic and curious approach may have.
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Affiliation(s)
- P McEvoy
- Six Degrees Social Enterprise, Salford, UK; School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Swall A, Ebbeskog B, Lundh Hagelin C, Fagerberg I. Can therapy dogs evoke awareness of one's past and present life in persons with Alzheimer′s disease? Int J Older People Nurs 2014; 10:84-93. [DOI: 10.1111/opn.12053] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Swall
- Department of Neurobiology, Caring Science and Social Science; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
| | - Britt Ebbeskog
- Department of Neurobiology, Caring Science and Social Science; Karolinska Institutet; Stockholm Sweden
| | - Carina Lundh Hagelin
- Sophiahemmet University; Stockholm Sweden
- Department of Learning, Informatics, Management and Ethics; Cancer and Palliative care; Karolinska Institutet; Stockholm Sweden
| | - Ingegerd Fagerberg
- Department of Neurobiology, Caring Science and Social Science; Karolinska Institutet; Stockholm Sweden
- Department of Health Care Science; Ersta Sköndal University College; Stockholm Sweden
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Hedman R, Hansebo G, Ternestedt BM, Hellström I, Norberg A. Expressed Sense of Self by People With Alzheimer’s Disease in a Support Group Interpreted in Terms of Agency and Communion. J Appl Gerontol 2014; 35:421-43. [DOI: 10.1177/0733464814530804] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 03/16/2014] [Indexed: 11/15/2022] Open
Abstract
The self is constructed in cooperation with other people and social context influences how people perceive and express it. People with Alzheimer’s disease (AD) often receive insufficient support in constructing their preferred selves, but little is known about how they express themselves together with other people with AD. In accordance with Harré’s social constructionist theory of self, this study aimed to describe how five people with mild and moderate AD express their Self 2 (i.e., their personal attributes and life histories) in a support group with a facilitator experienced in communicating with people with AD. The participants’ expressions of their Self 2 were analyzed with qualitative abductive content analysis and interpreted in terms of agency and communion and a lack of agency and communion. The findings highlight the importance of supporting a sense of agency and communion when assisting people with AD in constructing their self.
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Affiliation(s)
- Ragnhild Hedman
- Karolinska Institutet, Stockholm, Sweden
- Ersta Sköndal University College, Stockholm, Sweden
| | - Görel Hansebo
- Karolinska Institutet, Stockholm, Sweden
- Ersta Sköndal University College, Stockholm, Sweden
| | - Britt-Marie Ternestedt
- Karolinska Institutet, Stockholm, Sweden
- Ersta Sköndal University College, Stockholm, Sweden
| | - Ingrid Hellström
- Ersta Sköndal University College, Stockholm, Sweden
- Linköping University, Sweden
| | - Astrid Norberg
- Ersta Sköndal University College, Stockholm, Sweden
- Umeå University, Sweden
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Skaalvik MW, Norberg A, Normann K, Fjelltun AM, Asplund K. The experience of self and threats to sense of self among relatives caring for people with Alzheimer's disease. DEMENTIA 2014; 15:467-80. [PMID: 24535820 DOI: 10.1177/1471301214523438] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study explored how the relatives of people with Alzheimer's disease expressed Self 2 and Self 3 according to Harré's social constructionist theory of selfhood. Having a relative with Alzheimer's disease affects one's life. In this study, we concentrated on how close relatives of people with Alzheimer's disease experienced their sense of self. This study was descriptive and qualitative. Interviews were conducted with 20 relatives of 10 people with Alzheimer's disease from 2009 to 2011. The data were analysed according to Harré's social constructionist theory of selfhood including Selves 2 and 3. Participants reported that Alzheimer's disease challenged their personal attributes, relations and positioning. Understanding how Alzheimer's disease affects the sense of self among close relatives is important, as this knowledge is pivotal for supporting these relatives who are often informal caregivers in ways that enable a fulfilling and meaningful life.
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Affiliation(s)
- Mari Wolff Skaalvik
- Faculty of Health Sciences, Department of Health Care Sciences, Centre of Care Research, University of Tromsoe, Tromsoe, Norway
| | - Astrid Norberg
- Faculty of Health Sciences, Department of Health Care Sciences, Centre of Care Research, University of Tromsoe, Tromsoe, Norway
| | - Ketil Normann
- Faculty of Health Sciences, Department of Health Care Sciences, Centre of Care Research, University of Tromsoe, Tromsoe, Norway
| | - Aud-Mari Fjelltun
- Faculty of Health Sciences, Department of Health Care Sciences, Centre of Care Research, University of Tromsoe, Tromsoe, Norway
| | - Kenneth Asplund
- Faculty of Health Sciences, Department of Health Care Sciences, Centre of Care Research, University of Tromsoe, Tromsoe, Norway
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Social positioning by people with Alzheimer's disease in a support group. J Aging Stud 2014; 28:11-21. [DOI: 10.1016/j.jaging.2013.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 11/17/2013] [Accepted: 11/17/2013] [Indexed: 11/20/2022]
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