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Rantapää M, Virtanen IA, Pekkala S. Formal caregivers' perceptions of everyday interaction with Deaf people with dementia. Clin Gerontol 2023:1-14. [PMID: 36639979 DOI: 10.1080/07317115.2023.2167623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Deteriorating interactive ability of people with dementia challenges formal caregivers. In Finland, Deaf people with advanced dementia may live in a nursing home designed for their care where the staff use Finnish Sign Language (FiSL). This study describes the perceptions of formal caregivers, focusing on the challenges, how they solve the challenges, and what support they need to improve interaction with Deaf residents. METHODS Semi-structured interviews with 13 formal caregivers who work with Deaf people with dementia were conducted and analyzed using qualitative content analysis. A purposive sampling was used. RESULTS Three key themes were challenges in interaction, strategies in supporting interaction, and support for coping. Caregivers perceived challenges in interaction caused by linguistic changes, deteriorating physical mobility and memory, and Deaf residents' behavioral challenges. Caregivers supported Deaf residents by learning to know them and using personal and linguistic strategies. Support for coping comprised supporting family members and other caregivers. CONCLUSIONS Efficient skills in sign language (SL) and knowledge of dementia are essential in interacting with Deaf residents and to build interpersonal relationships for care. CLINICAL IMPLICATIONS Supporting Deaf residents requires learning the way they interact which can be achieved over time.
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Affiliation(s)
- Minna Rantapää
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Sieppijarvi, Finland
| | | | - Seija Pekkala
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Sieppijarvi, Finland
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Braithwaite Stuart L, Jones CH, Windle G. A qualitative systematic review of the role of families in supporting communication in people with dementia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1130-1153. [PMID: 35714124 PMCID: PMC9796329 DOI: 10.1111/1460-6984.12738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cognitive-communication difficulties are often associated with dementia and can impact a person's ability to participate in meaningful conversations. This can create challenges to families, reflecting the reality that people living with dementia rarely have just one regular conversation partner, but interact with multiple family members. To date, there is limited evidence of the impact of changes in communication patterns in families. A family systems approach, with foundations in psychology, can be used to explore the impact of communication difficulties on multiple different family members, including the person living with dementia and potential coping strategies used by individuals, together with the family as a whole. METHODS & PROCEDURES A systematic review of primary qualitative research was conducted to identify and examine research exploring communication and interaction within families living with dementia. Studies were identified through a comprehensive search of major databases and the full-text articles were subject to a quality appraisal. We conducted a thematic analysis on the literature identified to consider the role of families in supporting communication for people with dementia. OUTCOMES & RESULTS The searches identified 814 possible articles for screening against the eligibility criteria. Nine articles were included in the final review. Three major themes emerged from the analysis of the included studies: (1) 'identities changing' reflected how interactions within the family systems impacted on identities; (2) 'loss' reflected the grief experienced by families due to changes in communication; and (3) 'developing communication strategies' highlighted strategies and approaches that families affected by dementia may use organically to engage in meaningful interactions and maintain connection. Only one study explicitly used a family systems approach to understand how families manage the changes in interaction resulting from dementia. CONCLUSIONS & IMPLICATIONS The findings may usefully inform the clinical practice of speech and language therapists in terms of communication strategies and coping mechanisms that may be advised to facilitate connection in families living with dementia. Further research using a family systems approach to exploring communication in dementia may help to support the implementation of family-centred practice as recommended in policy. WHAT THIS PAPER ADDS What is already known on the subject There is increasing recognition of the impact of dementia on whole families and the need for family-centred interventions to enhance quality of life. However, much of the research to date that explores communication within families affected by dementia examines interaction between dyads, largely overlooking the roles and skills of other familial communication partners. To the authors' knowledge, there has been no previous review of the literature using a family systems approach, which has the potential to inform clinical practice of those working in dementia care. What this paper adds to existing knowledge The review examines and understands what is known about the approaches used by families affected by communication changes resulting from dementia to preserve connection. It collates the evidence from qualitative studies examining approaches and strategies used by individual conversation partners, including people with dementia, as well as the family system as a whole, to facilitate meaningful interactions, and proposes recommendations for clinicians working in this field. Furthermore, we consider the potential benefits of using a family systems approach to understand the context of people living with dementia and how this could enhance communication, personhood and well-being. What are the potential or actual clinical implications of this work? This review highlights practical conversation strategies and interactional approaches that may serve to enhance communication and preserve relationships between people with dementia and their family members. Such techniques have the potential to be advised by Speech and Language Therapists working in dementia care as part of tailored, relationship-centred care and support that they provide.
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Affiliation(s)
| | - Catrin Hedd Jones
- School of Medical and Health SciencesBangor UniversityBangorUK
- DSDC Wales Research CentreBIHMRSchool of Medical and Health SciencesBangorUK
| | - Gill Windle
- School of Medical and Health SciencesBangor UniversityBangorUK
- DSDC Wales Research CentreBIHMRSchool of Medical and Health SciencesBangorUK
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Chatwin J, Ludwin K, Latham I. Combining ethnography and conversation analysis to explore interaction in dementia care settings. Health Expect 2022; 25:2306-2313. [PMID: 35841622 PMCID: PMC9615051 DOI: 10.1111/hex.13563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background It is well established that the actions and behaviour of care home workers are fundamental to the well‐being of the people they care for. They not only deliver basic care but through their day‐to‐day presence provide an underlying continuity for residents, many of whom will have dementia or other cognitive problems. This can have many positive psychological and social benefits. A variety of ethnographic approaches have been used to explore the broader social and cultural dimensions of dementia care work. Similarly, there is a growing body of work applying micro‐level approaches such as conversation analysis (CA) to describe the interactional mechanics of specific care skills. Strategy We outline what ethnography and CA are, how they work as stand‐alone methodologies and how they have been used in care work and dementia care settings. A working illustration is given of how the two approaches may be integrated. Discussion Dementia care workers occupy a uniquely tenuous sociopolitical and professional position within healthcare. If they are to progress to a more professional status there is a pressing need for standardized systems of training to be developed. As has been common practice in most other fully professionalized sectors of healthcare, this training needs to be backed up by an understanding of how effective care work is undertaken at the micro‐level. For it to be practically relevant to care workers it also needs to have been informed by the wider social context in which it occurs. Conclusion We argue that elements of ethnography and CA can be usefully combined to provide the fully contextualized micro‐level descriptions of care work practice that will be needed if current moves towards the greater professionalization of care work are to continue. Patient or Public Contribution The authors undertake a significant amount of Patient and Public Involvement and Engagement and study codesign with members of the public, care workers and people living with dementia. Our engagement work with care staff and family carers undertaken as part of a current National Institute for Health Research study exploring naturalistic care worker skills (see acknowledgements) has been particularly relevant in shaping this article.
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Affiliation(s)
- John Chatwin
- Research and Innovation, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Katherine Ludwin
- Research and Innovation, Midlands Partnership NHS Foundation Trust, Stafford, UK
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The Development and Psychometric Validation of a Comprehensive Measure Assessing Fear of Incompetence among Adults Who Have a Family Member with Dementia. Int J Alzheimers Dis 2020; 2020:1910252. [PMID: 32206348 PMCID: PMC7016475 DOI: 10.1155/2020/1910252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/07/2019] [Indexed: 11/18/2022] Open
Abstract
Because the interpersonal skills of individuals with dementia often decline, family members may question their own ability to interact meaningfully. These family members may experience fear of incompetence (i.e., fear of being unable to relate in a meaningful way or take care of a close family member with dementia). Thus, the goal of this research was to develop, refine, and psychometrically validate a scale (Fear of Incompetence—Dementia Scale; FOI-D) assessing fear of incompetence in the context of relationships with a close family member diagnosed with dementia. Three online studies were conducted to accomplish the primary objective. In Study One, the factor structure of the FOI-D was assessed by conducting an exploratory factor analysis using data from 710 adults who indicated having a close living family member who had been diagnosed with dementia. In Study Two, the factor structure was validated via a confirmatory factor analysis and the psychometric properties were established using data from 636 adults who had a family member with dementia. Finally, Study Three determined the temporal consistency of the scale by retesting 58 participants from Study Two. The results from Study One indicated that the FOI-D Scale accounted for 51.75% of the variance and was comprised of three subscales: the Interaction Concerns subscale, the Caregiving Concerns subscale, and the Knowledge Concerns subscale. In Study Two, the three-factor structure was supported, resulting in a 58-item scale. Investigation of the psychometric properties demonstrated the FOI-D to be reliable and valid. In Study Three, the FOI-D Scale demonstrated excellent temporal consistency. This research provides future investigators, educators, and practitioners with an adaptable comprehensive tool assessing fear of incompetence in a variety of settings.
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Dooley S, Walshe M. Assessing cognitive communication skills in dementia: a scoping review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:729-741. [PMID: 31250524 DOI: 10.1111/1460-6984.12485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 05/17/2019] [Accepted: 05/26/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cognitive communication difficulties are a characteristic feature of dementia. These deficits have negative effects on all aspects of daily life. Yet, there are few options for standardized assessment of cognitive communication skills in people with dementia. AIMS To review published cognitive-communication assessments to determine what psychometrically sound assessments exist that are applicable to all people with dementia. METHODS & PROCEDURES A scoping review of the literature was conducted using an established scoping review model. Cognitive-communication assessments validated in English with people with dementia were sought. A comprehensive search of eight relevant electronic databases was undertaken. Two reviewers independently analysed and assessed the psychometric quality of instruments that met inclusion criteria. OUTCOMES & RESULTS Four cognitive-communication assessments were included in the review. Although psychometrically sound, none was suitable for administration at all stages of dementia. Only one was validated for different dementia types. None included subtests for evaluation of conversation ability, and none involved the evaluation of communication partners' communication. CONCLUSIONS & IMPLICATIONS There are limited options for standardized communication assessment for individuals with dementia and their communication partners. Directions for the development of new measures are provided to facilitate research and improve clinical practice.
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Affiliation(s)
- Suzanna Dooley
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
- St Columcille's Hospital HSE, Loughlinstown, Co., Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Miron AM, Thompson AE, Bagley A, Anderson J, Melotik E, Rowley S. Fear of Incompetence in Intergenerational Relationships with a Family Member with Dementia. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2019. [DOI: 10.1080/15350770.2019.1575783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Anca M. Miron
- University of Wisconsin Oshkosh, Oshkosh, Wisconsin, USA
| | | | | | | | - Emma Melotik
- University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA
| | - Sarah Rowley
- University of Wisconsin Oshkosh, Oshkosh, Wisconsin, USA
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de la Fuente Garcia S, Ritchie CW, Luz S. Protocol for a conversation-based analysis study: PREVENT-ED investigates dialogue features that may help predict dementia onset in later life. BMJ Open 2019; 9:e026254. [PMID: 30918035 PMCID: PMC6475209 DOI: 10.1136/bmjopen-2018-026254] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/10/2019] [Accepted: 02/22/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Decreasing the incidence of Alzheimer's disease (AD) is a global public health priority. Early detection of AD is an important requisite for the implementation of prevention strategies towards this goal. While it is plausible that patients at the early stages of AD may exhibit subtle behavioural signs of neurodegeneration, neuropsychological testing seems unable to detect these signs in preclinical AD. Recent studies indicate that spontaneous speech data, which can be collected frequently and naturally, provide good predictors for AD detection in cohorts with a clinical diagnosis. The potential of models based on such data for detecting preclinical AD remains unknown. METHODS AND ANALYSIS The PREVENT-Elicitation of Dialogues (PREVENT-ED) study builds on the PREVENT Dementia project to investigate whether early behavioural signs of AD may be detected through dialogue interaction. Participants recruited through PREVENT, aged 40-59 at baseline, will be included in this study. We will use speech processing and machine learning methods to assess how well speech and visuospatial markers agree with neuropsychological, biomarker, clinical, lifestyle and genetic data from the PREVENT cohort. ETHICS AND DISSEMINATION There are no expected risks or burdens to participants. The procedures are not invasive and do not raise significant ethical issues. We only approach healthy consenting adults and all participants will be informed that this is an exploratory study and therefore has no diagnostic aim. Confidentiality aspects such as data encryption and storage comply with the General Data Protection Regulation and with the requirements from sponsoring bodies and ethical committees. This study has been granted ethical approval by the London-Surrey Research Ethics Committee (REC reference No: 18/LO/0860), and by Caldicott and Information Governance (reference No: CRD18048). PREVENT-ED results will be published in peer-reviewed journals.
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Affiliation(s)
- Sofia de la Fuente Garcia
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh School of Molecular Genetic and Population Health Sciences, Edinburgh, UK
| | - Craig W Ritchie
- Centre for Clinical Brain Sciences, Department of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Saturnino Luz
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh School of Molecular Genetic and Population Health Sciences, Edinburgh, UK
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Abstract
We used a morality of care perspective to examine how grandchildren cope with having to deceive or lie to their grandparent with dementia. Data from interviews with 13 young adults were analyzed using interpretative phenomenological analysis. We found that a moral orientation shift toward a person-centered morality of care occurs gradually. Grandchildren struggle with concepts of moral goodness, importance of close others, and questions about self as a moral agent. We uncovered three antecedents of this shift (severity of dementia symptoms, valuing of the grandparent's welfare, and valuing of the relationship) and three outcomes (transformation of moral self, changed relationship with the grandparent, and changed family relationships). Implications of a morality of care in intergenerational dementia relationships are discussed.
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Gerritsen DL, Koopmans RTCM, Walravens V, van Vliet D. Using Video Feedback at Home in Dementia Care: A Feasibility Study. Am J Alzheimers Dis Other Demen 2018; 34:153-162. [PMID: 30352521 PMCID: PMC6463273 DOI: 10.1177/1533317518808021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Video feedback at home (VFH) aims to improve the well-being of informal caregivers and persons with dementia by training the caregiver to communicate successfully. This feasibility study had 2 aims: (1) to investigate possible effects regarding VFH, caregiver self-efficacy and the burden experienced, and the frequency of challenging behavior in persons with dementia, and (2) to perform a process evaluation of barriers and facilitators regarding the use of VFH. The respondents were caregivers of home-dwelling persons with dementia participating in VHF (N = 10), a group of caregivers who declined participating in VFH (N = 18), stakeholders (N = 6), and field experts (N = 55). The assessments performed were Positive and Negative Affect Scales, Cohen-Mansfield Agitation Inventory, Sense of Competence Scale, semistructured interviews, and questionnaires. Results demonstrated that caregivers were satisfied with VFH and that various (sub)scores on questionnaires improved. Caregivers mentioned a reluctance toward being filmed and both caregivers and referrers were unfamiliar with VFH. Recommendations have been made for health-care professionals and researchers to overcome these barriers.
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Affiliation(s)
- Debby L Gerritsen
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands.,3 Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands.,4 Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Veerle Walravens
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands
| | - Deliane van Vliet
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands
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Whelan BM, Angus D, Wiles J, Chenery HJ, Conway ER, Copland DA, Atay C, Angwin AJ. Toward the Development of SMART Communication Technology: Automating the Analysis of Communicative Trouble and Repair in Dementia. Innov Aging 2018; 2:igy034. [PMID: 30539162 PMCID: PMC6276976 DOI: 10.1093/geroni/igy034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Communication difficulties have been reported as one of the most stress-inducing aspects of caring for people with dementia. Notably, with disease progression comes an increase in the frequency of communication difficulty and a reduction in the effectiveness of attempts to remedy breakdowns in communication. The aim of the current research was to evaluate the utility of an automated discourse analysis tool (i.e., Discursis) in distinguishing between different types of trouble and repair signaling behaviors, demonstrated within conversations between people with dementia and their professional care staff. RESEARCH DESIGN AND METHODS Twenty conversations between people with dementia and their professional care staff were human-coded for instances of interactive/noninteractive trouble and typical/facilitative repair behaviors. Associations were then examined between these behaviors and recurrence metrics generated by Discursis. RESULTS Significant associations were identified between Discursis metrics, trouble-indicating, and repair behaviors. DISCUSSION AND IMPLICATIONS These results suggest that discourse analysis software is capable of discriminating between different types of trouble and repair signaling behavior, on the basis of term recurrence calculated across speaker turns. The subsequent recurrence metrics generated by Discursis offer a means of automating the analysis of episodes of conversational trouble and repair. This achievement represents the first step toward the future development of an intelligent assistant that can analyze conversations in real time and offers support to people with dementia and their carers during periods of communicative trouble.
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Affiliation(s)
- Brooke-Mai Whelan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Daniel Angus
- School of Communication and Arts, Faculty of Humanities and Social Sciences, University of Queensland, Brisbane, Australia
| | - Janet Wiles
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture and Information Technology, University of Queensland, Brisbane, Australia
| | - Helen J Chenery
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Erin R Conway
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - Christina Atay
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture and Information Technology, University of Queensland, Brisbane, Australia
| | - Anthony J Angwin
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
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Kindell J, Keady J, Sage K, Wilkinson R. Everyday conversation in dementia: a review of the literature to inform research and practice. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2017; 52:392-406. [PMID: 27891726 PMCID: PMC5467725 DOI: 10.1111/1460-6984.12298] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 09/14/2016] [Accepted: 09/17/2016] [Indexed: 05/31/2023]
Abstract
BACKGROUND There has been increasing interest in dementia care in recent years, including how practitioners, service providers and society in general can help individuals to live well with the condition. An important aspect to this is provision of advice to ensure conversation partners effectively support the person with dementia in conversation. AIMS To provide a descriptive review of the literature examining everyday conversation in dementia in order to inform practice and research. METHODS & PROCEDURES This review used a method specifically developed for reviewing conversation analytic and related literature. A range of databases were searched using key words and explicitly described inclusion criteria leading to a final corpus of 50 titles. Using this qualitative methodology, each paper was examined and data extracted. The contribution of each of these is described and the implications for practice and research are outlined. MAIN CONTRIBUTION This review examined studies into conversation in Alzheimer's disease, vascular dementia and Lewy body dementia, grouping these into: early influential studies; work drawing on positioning theory; studies using social and linguistic approaches; collaborative storytelling; formulaic language; studies specifically using conversation analysis; and conversation as a target for individualized therapy. In addition, more recent work examining primary progressive aphasia and behavioural variant frontotemporal dementia was explored. Overall, this review indicates that research examining conversation in natural settings provides a rich source of data to explore not just the challenges within conversation for those taking part, but also the skills retained by the person with dementia. An important aspect of this understanding is the notion that these skills relate not only to information exchange but also aspects of social interaction. The role of others in scaffolding the conversation abilities of the person with dementia and the potential of this for developing interventions are discussed. CONCLUSIONS & IMPLICATIONS The review indicates that interventions targeting conversation in dementia are often advocated in the literature but currently such approaches remain to be systematically evaluated. In addition, many of the important insights arising from these studies have yet to inform multidisciplinary dementia care practice.
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Affiliation(s)
| | - John Keady
- School of Nursing, Midwifery and Social Work/Greater Manchester West Mental Health NHS Foundation TrustUniversity of ManchesterManchesterUK
| | - Karen Sage
- Centre for Health and Social Care Research and the Department of Allied Health Professions, Sheffield Hallam UniversitySheffieldUK
| | - Ray Wilkinson
- Department of Human Communication SciencesUniversity of SheffieldSheffieldUK
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Closs SJ, Dowding D, Allcock N, Hulme C, Keady J, Sampson EL, Briggs M, Corbett A, Esterhuizen P, Holmes J, James K, Lasrado R, Long A, McGinnis E, O’Dwyer J, Swarbrick C, Lichtner V. Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BackgroundPain and dementia are common in older people, and impaired cognitive abilities make it difficult for them to communicate their pain. Pain, if poorly managed, impairs health and well-being. Accurate pain assessment in this vulnerable group is challenging for hospital staff, but essential for appropriate management. Robust methods for identifying, assessing and managing pain are needed.Aims and objectivesTwo studies were undertaken to inform the development of a decision support tool to aid hospital staff in the recognition, assessment and management of pain. The first was a meta-review of systematic reviews of observational pain assessment instruments with three objectives: (1) to identify the tools available to assess pain in adults with dementia; (2) to identify in which settings they were used and with what patient populations; and (3) to assess their reliability, validity and clinical utility. The second was a multisite observational study in hospitals with four objectives: (1) to identify information currently used by clinicians when detecting and managing pain in patients with dementia; (2) to explore existing processes for detecting and managing pain in these patients; (3) to identify the role (actual/potential) of carers in this process; and (4) to explore the organisational context in which health professionals operate. Findings also informed development of health economics data collection forms to evaluate the implementation of a new decision support intervention in hospitals.MethodsFor the meta-review of systematic reviews, 12 databases were searched. Reviews of observational pain assessment instruments that provided psychometric data were included. Papers were quality assessed and data combined using narrative synthesis. The observational study used an ethnographic approach in 11 wards in four UK hospitals. This included non-participant observation of 31 patients, audits of patient records, semistructured interviews with 52 staff and four carers, informal conversations with staff and carers and analysis of ward documents and policies. Thematic analysis of the data was undertaken by the project team.ResultsData from eight systematic reviews including 28 tools were included in the meta-review. Most tools showed moderate to good reliability, but information about validity, feasibility and clinical utility was scarce. The observational study showed complex ward cultures and routines, with variations in time spent with patients, communication patterns and management practices. Carer involvement was rare. No pain decision support tools were observed in practice. Information about pain was elicited in different ways, at different times, by different health-care staff and recorded in separate documents. Individual staff made sense of patients’ pain by creating their own ‘overall picture’ from available information.LimitationsGrey literature and non-English-language papers were excluded from the meta-review. Sample sizes in the observational study were smaller than planned owing to poor documentation of patients’ dementia diagnoses, gatekeeping by staff and difficulties in gaining consent/assent. Many patients had no or geographically distant carers, or a spouse who was too unwell and/or reluctant to participate.ConclusionsNo single observational pain scale was clearly superior to any other. The traditional linear concept of pain being assessed, treated and reassessed by single individuals did not ‘fit’ with clinical reality. A new approach enabling effective communication among patients, carers and staff, centralised recording of pain-related information, and an extended range of pain management interventions is proposed [Pain And Dementia Decision Support (PADDS)]. This was not tested with users, but a follow-on study aims to codesign PADDS with carers and clinicians, then introduce education on staff/patient/carer communications and use of PADDS within a structured implementation plan. PADDS will need to be tested in differing ward contexts.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- S José Closs
- School of Healthcare, University of Leeds, Leeds, UK
| | - Dawn Dowding
- School of Nursing, Columbia University, New York, NY, USA
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Nick Allcock
- Clinical Specialist, Pain Management Solutions, Nottingham, UK
| | - Claire Hulme
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - John Keady
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Michelle Briggs
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
| | | | - John Holmes
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - Kirstin James
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | - Reena Lasrado
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Andrew Long
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - John O’Dwyer
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Caroline Swarbrick
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Lindholm C. Boundaries of participation in care home settings: Use of the Swedish token jaså by a person with dementia. CLINICAL LINGUISTICS & PHONETICS 2016; 30:832-848. [PMID: 27624538 DOI: 10.1080/02699206.2016.1208275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article is a conversation analytic study of how one elderly person with dementia and her interlocutors interact in a care home setting. Participation is studied in the form of responsive action of the person with dementia, focusing on the Swedish response token 'jaså,' which has not previously been analysed in detail. The central claim is that even though the sequential placement of the response token indicates interactional competence, other factors reveal limited competence and communication impairment. First, the person with dementia's use of gaze is reduced, and she seems to rely on the auditory but not on the visual channel. Second, the interlocutors do not in all situations treat her as a ratified participant in spite of her attempts to contribute to the interaction. This study contributes both to the study of participation in the context of communication impairment and to the study of response tokens in Swedish.
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Affiliation(s)
- Camilla Lindholm
- a Department of Finnish , Finno-Ugrian and Scandinavian Studies, University of Helsinki , Helsinki , Finland
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14
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Lichtner V, Dowding D, Allcock N, Keady J, Sampson EL, Briggs M, Corbett A, James K, Lasrado R, Swarbrick C, Closs SJ. The assessment and management of pain in patients with dementia in hospital settings: a multi-case exploratory study from a decision making perspective. BMC Health Serv Res 2016; 16:427. [PMID: 27553364 PMCID: PMC4995653 DOI: 10.1186/s12913-016-1690-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain is often poorly managed in people who have a dementia. Little is known about how this patient population is managed in hospital, with research to date focused mainly on care homes. This study aimed to investigate how pain is recognised, assessed and managed in patients with dementia in a range of acute hospital wards, to inform the development of a decision support tool to improve pain management for this group. METHODS A qualitative, multi-site exploratory case study. Data were collected in four hospitals in England and Scotland. Methods included non-participant observations, audits of patient records, semi-structured interviews with staff and carers, and analysis of hospital ward documents. Thematic analysis was performed through the lens of decision making theory. RESULTS Staff generally relied on patients' self-report of pain. For patients with dementia, however, communication difficulties experienced because of their condition, the organisational context, and time frames of staff interactions, hindered patients' ability to provide staff with information about their pain experience. This potentially undermined the trials of medications used to provide pain relief to each patient and assessments of their responses to these treatments. Furthermore, given the multidisciplinary environment, a patient's communication about their pain involved several members of staff, each having to make sense of the patient's pain as in an 'overall picture'. Information about patients' pain, elicited in different ways, at different times and by different health care staff, was fragmented in paper-based documentation. Re-assembling the pieces to form a 'patient specific picture of the pain' required collective staff memory, 'mental computation' and time. CONCLUSIONS There is a need for an efficient method of eliciting and centralizing all pain-related information for patients with dementia, which is distributed in time and between personnel. Such a method should give an overall picture of a patient's pain which is rapidly accessible to all involved in their care. This would provide a much-needed basis for making decisions to support the effective management of the pain of older people with dementia in hospital.
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Affiliation(s)
| | - Dawn Dowding
- Columbia University School of Nursing, New York, NY 10032 USA
- Center for Home Care Policy and Research, Visiting Nursing Service of New York, New York, NY USA
| | - Nick Allcock
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - John Keady
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Michelle Briggs
- Centre for Pain Research, Leeds Beckett University, Leeds, UK
| | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
| | - Kirstin James
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | - Reena Lasrado
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Caroline Swarbrick
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - S. José Closs
- School of Healthcare, University of Leeds, Leeds, UK
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15
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Jones D, Drew P, Elsey C, Blackburn D, Wakefield S, Harkness K, Reuber M. Conversational assessment in memory clinic encounters: interactional profiling for differentiating dementia from functional memory disorders. Aging Ment Health 2016; 20:500-9. [PMID: 25803169 DOI: 10.1080/13607863.2015.1021753] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES In the UK dementia is under-diagnosed, there is limited access to specialist memory clinics, and many of the patients referred to such clinics are ultimately found to have functional (non-progressive) memory disorders (FMD), rather than a neurodegenerative disorder. Government initiatives on 'timely diagnosis' aim to improve the rate and quality of diagnosis for those with dementia. This study seeks to improve the screening and diagnostic process by analysing communication between clinicians and patients during initial specialist clinic visits. Establishing differential conversational profiles could help the timely differential diagnosis of memory complaints. METHOD This study is based on video- and audio recordings of 25 initial consultations between neurologists and patients referred to a UK memory clinic. Conversation analysis was used to explore recurrent communicative practices associated with each diagnostic group. RESULTS Two discrete conversational profiles began to emerge, to help differentiate between patients with dementia and functional memory complaints, based on (1) whether the patient is able to answer questions about personal information; (2) whether they can display working memory in interaction; (3) whether they are able to respond to compound questions; (4) the time taken to respond to questions; and (5) the level of detail they offer when providing an account of their memory failure experiences. CONCLUSION The distinctive conversational profiles observed in patients with functional memory complaints on the one hand and neurodegenerative memory conditions on the other suggest that conversational profiling can support the differential diagnosis of functional and neurodegenerative memory disorders.
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Affiliation(s)
- Danielle Jones
- a School of Dementia Studies, Faculty of Health Studies , University of Bradford , Bradford , UK
| | - Paul Drew
- b Department of Social Sciences , Loughborough University , Leicestershire , UK
| | - Christopher Elsey
- b Department of Social Sciences , Loughborough University , Leicestershire , UK
| | - Daniel Blackburn
- c Sheffield Institute for Translational Neuroscience (SITraN) , University of Sheffield , Sheffield , UK
| | - Sarah Wakefield
- d Department of Neuroscience, Medical School , University of Sheffield , Sheffield , UK
| | - Kirsty Harkness
- e Department of Neurology , Royal Hallamshire Hospital , Sheffield , UK
| | - Markus Reuber
- f Academic Neurology Unit , University of Sheffield , Royal Hallamshire Hospital, Sheffield , UK
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