Ethical implications of the perception and portrayal of dementia

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

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

Healthcare professionals' experiences and views of providing continence support and advice to people living at home with dementia: "That's a carer's job"

BACKGROUND

People living with dementia at home and their family carers often feel unsupported by healthcare professionals in managing continence problems. In turn, primary and community-based healthcare professionals have reported lacking specific knowledge on dementia-continence. This study aimed to understand more about healthcare professionals' experiences and views of supporting people living with dementia experiencing continence problems, as part of developing acceptable resources. Having a nuanced understanding of unmet need would facilitate the design of engaging resources that enable healthcare professionals to provide more effective continence support to people living with dementia at home.

METHODS

Semi-structured interviews were conducted with a range of healthcare professionals (n = 31) working in primary and community care in the South of England in 2023. Transcribed interviews were uploaded to NVivo 12, then analysed inductively and deductively using a thematic framework.

RESULTS

Continence-related conversations were avoided by many healthcare professionals due to lack of dementia-continence specific knowledge. Many considered that continence problems of people living with dementia were largely outside their remit once a physical cause had been ruled out. This contributed to a lack of priority and proactivity in raising the subject of continence in their consultations. Challenges to providing support included limited consultation time and lack of access to specialist services with availability to support individuals.

CONCLUSION

There is substantial scope to support primary and community-based healthcare professionals in their provision of continence-related support and advice to people living at home with dementia. This includes addressing knowledge deficits, enhancing confidence and instilling a sense of accomplishment.

Age Advocacy on Twitter Over 12 Years

BACKGROUND AND OBJECTIVES

Discussions on age-related issues have begun taking place in earnest, but exactly what dominates public consciousness about these issues is a topic that has yet to kindle scholarly attention. This study analyzes tweets uploaded by age advocacy organizations that have attracted the highest levels of engagement on Twitter.

RESEARCH DESIGN AND METHODS

We collected 403,426 tweets from 53 accounts. These tweets were posted over 12 years, from 2009 to 2021. After applying our exclusion criteria and collating the top 1% of tweets with the highest levels of engagement, 2,054 tweets were retained for analysis. Both inductive and deductive approaches informed our qualitative content analysis.

RESULTS

Five themes emerged. "Issues Related to Alzheimer's Disease or Dementia" (Theme 1) formed the majority of tweets (62%; N = 1,278). Theme 2 "Rising Health Care or Retirement Costs" was the second largest theme (25%; N = 506). Seven percent of the tweets were on "Reframing Aging and Combating Ageism" (Theme 3; N = 138). "Matters Affecting Caregivers" surfaced in Theme 4 (4%; N = 81). Two percent of the tweets were on "Intersectional Concerns" (Theme 5; N = 51).

DISCUSSION AND IMPLICATIONS

As age advocacy organizations step up to engage the public constructively in matters regarding later life, there is a compelling need to quell public anxiety about old age and to sensitize society to the struggles confronted by older adults. In undertaking the range of activities needed to do so, age advocacy organizations should consolidate efforts even as they rethink existing strategies to effectuate change.

Identifying Stigmatizing Language Used by Israelis and Germans With a Mild Neurocognitive Disorder, Their Relatives, and Caregivers of People With Alzheimer's Disease

OBJECTIVES

The purpose of the study was to examine and compare the dementia-related discourse and language used by people with mild neurocognitive disorder (MND), their family members, and family caregivers of people with Alzheimer's disease in Israel and Germany.

DESIGN

This secondary qualitative analysis included focus groups and semistructured interviews. Thematic analysis was used to reveal the main discourses and stigmatic language used regarding dementia and people with dementia.

SETTING

Israeli and German stakeholders.

PARTICIPANTS

Forty-four Israeli and 44 German participants: 28 people with MND, 20 family members of people with MND, and 40 family caregivers of people with Alzheimer's disease.

RESULTS

Two main discourses were identified: the tragedy and the biomedical discourse. The tragedy discourse included several subthemes: "Dementia as the worst-case scenario," "Nothing can be done about dementia," and "People with dementia are not human." The biomedical discourse stressed pathologic aspects of the condition. Similarities and differences were found between Israeli and German participants.

CONCLUSIONS

The study indicates that, despite culture and language differences, the use of stigmatic discourse and stigmatizing language is common among people with close exposure to dementia in Israel and Germany. Efforts should be increased to develop a person-centered and dementia-friendly language.

People with young-onset dementia and their family caregivers discussing euthanasia: A qualitative analysis of their considerations

OBJECTIVES

Research showed that people with young-onset dementia and their family caregivers raised the topic of euthanasia when talking about the broader topic of advance care planning. A better understanding of what people address and why may inform the evolving landscape of physician assisted dying. This study aimed to explore the considerations that people with young-onset dementia and their family caregivers expressed on euthanasia.

METHODS

A secondary qualitative analysis on interviews with 10 Belgian people with young-onset dementia and 25 family caregivers, using constant comparative analysis.

RESULTS

Respondents described similar contexts in which euthanasia had been discussed: the topic arose at 'key' moments, mostly with family caregivers, and was motivated by patients considering the impact of disease progression for themselves and their loved-ones. Caregivers shared opinions on the euthanasia law and discussed the emotional impact of discussing euthanasia.

CONCLUSIONS

Considerations of people with young-onset dementia towards euthanasia appear rooted in personal, as well as in anticipated interpersonal and societal suffering. The negative image associated with dementia and dementia care seemed to influence people's expectations for and thoughts on the future.

PRACTICE IMPLICATIONS

Patient-physician communication should include detangling motives for euthanasia requests, openly discussing fears and reflecting on prognosis.

Living Well with Dementia: Feeling Empowered through Interaction with Their Social Environment

This study was designed to advance our understanding of how feelings of empowerment in people living with dementia still residing at home can be promoted. We conducted qualitative interviews with 12 participants with mild-to-moderate stages of dementia in Germany and Spain as part of a European study on mindful design for dementia. A qualitative thematic content analysis was performed to elicit the key features of the experience reported by the interviewees. Three overarching categories were identified: the first category 'experiencing changes in personal life and coping with changes in life' covered losses and coping strategies; the second category 'retaining a sense of usefulness' included social participation and the need for activities with others; the third category 'feeling empowered' covered reflections on lifetime achievements, accomplishments in the present life, being in control and self-worth. Participants placed a strong emphasis on continuity and on the importance of making active decisions and meaningful social contributions. Empowerment within the person living with dementia was achieved through their interactions with their social environment, including the significance of communication about their needs and wishes and enabling shared decision-making and interactions with others in reciprocity.

Alzheimer's disease (AD) knowledge in Korean Americans: identifying knowledge gaps and misconceptions and examining predictors of AD knowledge

OBJECTIVES

This study examined Alzheimer's disease (AD) knowledge and its predictors among Korean Americans (KAs).

DESIGN

Convenience sampling was used to recruit KAs in the Greater Washington metropolitan area. A total of 268 KAs participated in the study and completed a cross-sectional survey in 2014. Using the Alzheimer's Disease Knowledge Scale (ADKS), overall and domain knowledge was assessed. Multiple regression analyses were conducted for overall and domain knowledge with predictors including exposure to AD, social engagement, sources and frequency of health-related information, stigmatic beliefs (pity, antipathy, and social distance), English proficiency, and education.

RESULTS

KAs reported a 59% accuracy in the overall AD knowledge. At the domain level, KAs were most knowledgeable about assessment and diagnosis and least knowledgeable about caregiving. Our regression analyses showed that having a college degree or higher is associated with a greater overall AD knowledge. Three domain models of life impact, risk factors, and caregiving turned out to be significant: Having a college degree or higher is a predictor of greater knowledge in all three domains. Having more pity stigmatic beliefs is related to greater knowledge in both life impact and caregiving domains while having less pity stigmatic beliefs is associated with more risk factor knowledge; having less social distance stigmatic beliefs is associated with greater life impact knowledge; and having less antipathy stigmatic beliefs is related to better caregiving knowledge.

CONCLUSION

Our findings revealed areas of misconceptions and knowledge gaps in KAs which need to be addressed in educational interventions. Different knowledge status across the domains demonstrates a multi-dimensional nature of AD knowledge. Multivariate findings confirmed the robust role of education in overall and domain AD knowledge. The effect of different AD stigmatic beliefs on certain AD knowledge domains suggests ways of how stigma change can be efficient for the purpose of increasing AD domain knowledge in KAs.

Blogging through dementia: Reworking mainstream discourse through metaphor in online early-onset dementia narratives

Background

The depiction of dementia in public discourse tends to operate on two levels: the tragedy discourse or the living well with dementia discourse, where metaphors play a decisive role in the characterization of the condition and the voice of those living with the condition is usually underrepresented.

Purpose

This article analyzes whether and how mainstream discourse on dementia is reworked in first-person accounts of the disease online and explores the attitudes and assumptions about dementia that illness blogs reflect and defy.

Study design

Drawing on Conceptual Metaphor Theory, the article analyzes a corpus of 10 blogs (622 posts) written by individuals living with early-onset dementia to identify the metaphors used to depict dementia, its impact on the self and its social and relational aspects. Metaphor identification was based on the PRAGGLEJAZ metaphor identification procedure.

Results

The study demonstrates that across blogs no single metaphor alone is capable of capturing the complexity of the dementia experience; instead multiple metaphors are deployed to provide a characterization of the multiple faces of this condition. In this way blogs transcend and reshape the reductionist view of dementia that emerges from the either/or dichotomy of the tragedy versus living well with dementia discourses that dominate in media representations. By reshaping some of the metaphors used in mainstream discourse and introducing new ones, blog narratives draw attention to the complex nature of the experience of dementia, acknowledging both the suffering and social and functional losses that the condition brings, while also claiming recognition for personhood, agency, validation, and the aspiration to grow beyond the diagnosis and live a valued life as part of a family and community.

Conclusions

Overall, this study demonstrates that metaphor is a useful tool for providing insights into people’s experience of dementia and that blogs are a platform where stereotypes may be defied and mainstream representations of dementia reworked offering a more holistic view of the condition and granting narrative agency to those who live with dementia.

The "Alzheimer Village": Assessment of Alzheimer's disease representations in the general population: A cross sectional phone survey

INTRODUCTION

In most countries, the societal view of Alzheimer's disease (AD) is very negative. The initiatives that are part of the so-called "dementia-friendly approach" aim not only at promoting well-being and dignity of persons suffering from AD but also improving the way they are regarded and their inclusion in society. Unfortunately, scarce research has been conducted to assess whether such goals can be achieved. In France, the experimental Alzheimer Village in Dax is designed as a dementia-friendly community. Due to the recent opening (2020) and the strong local media coverage of this project, a survey has been designed to determine whether the representations of AD have been impacted by such a project.

METHODS

The survey was conducted before and after the opening of the Alzheimer Village in the city of Dax (hosting the village) and surrounding areas, and in a control city with similar socio-demographics. The analyses intend to compare different dimensions of the representations and attitudes toward AD in the general population.

RESULTS

A total of 423 persons living in the Alzheimer Village city (37.4% were men) and 415 persons living in the control city (40.2% were men) were interviewed, resulting in 838 complete questionnaires. The main results report significantly lower rating in the perception of loss of identity (β = -0.57, P = .014) and in the feeling of disgust for persons with AD (β = -0.61, P = .008) in the city hosting the village after the opening of the Alzheimer Village. No significant changes were seen in the control city sample.

DISCUSSION

While societal representations of AD are very robust and difficult to change, this study suggests a modest but significant evolution of representations of AD in the surrounding areas of the Alzheimer Village.

HIGHLIGHTS

The French Alzheimer Village is one of the very few ones in the world.This is the first study assessing the impact of an Alzheimer Village on disease representations.After the opening of the village, attitudes toward Alzheimer's disease have changed.

Conceptualizing How Caregiving Relationships Connect to Quality of Family Caregiving within the Stress Process Model

Family caregivers provide the majority of care for older and disabled family members living with an illness or disability. Although most caregivers want to provide high-quality care, many report providing care that is potentially harmful. We apply the Stress Process Model to review the preponderance of literature implicating quality of the relationship between caregivers and care recipients as a factor contributing to quality of family caregiving. In drawing together literature on caregiving relationships and caregiving quality, this commentary identifies potentially modifiable intervention targets to develop programs to support high-quality caregiving to older adults living with a chronic illness or disability.

Representations of the experiences of people with dementia in Irish newspapers

The aims of the study were to explore what personal narratives in Irish broadsheet and tabloid newspapers reveal about the lived experience of people with dementia. The sample included twenty narratives collected from five Irish newspapers between 2011 and 2017 inclusively. The relative absence of narratives of people with dementia in Irish newspapers is shown as only twelve of the twenty narratives contained the voice of the person with dementia themselves. Inductive analysis and thematic analysis generated four main themes with a total of thirteen subthemes. The main themes are: (1) Dementia as a personal journey, (2) stereotypes and stigma, (3) barriers and (4) awareness. This study highlights the under-representation of personal narratives of people with dementia in Irish newspapers which is seen as a contributing factor in the lack of understanding and awareness of dementia in society in general. Exploring mediated representations of the lived experience of people with dementia through personal narratives provides insight into the naturalised discourses of dementia which impact on people's lived experiences. (172).

Dementia and primary care teams: obstacles to the implementation of Portugal's Dementia Strategy

Background:

Portugal has a Dementia Strategy that endorses care coordination in the community, but the strategy is not implemented despite there being a network of multidisciplinary primary care clinics that could support it. Recent research into barriers to dementia management in primary care has focused essentially on general practitioners’ (GPs) factors and perspectives. A comprehensive triangulated view on the barriers to dementia management emphasising teamwork is missing.

Aim:

To explore the barriers to the implementation of the Portuguese Dementia Strategy by primary care teams, from the perspectives of service users and professionals.

Methods:

Purposive sampling was used to recruit 10 GPs, 8 practice nurses, 4 social workers, 8 people with dementia and 10 family carers from 6 practices in different social contexts within the Lisbon metropolitan area. The analytical framework combined codes derived from the transcripts with codes from the available literature. Themes focused on the access to professionals/community services, care coordination within healthcare teams, and between health and community services.

Findings:

Several system barriers were identified (undefined roles/coordination within teams, time constraints, insufficient signposting to community services) along with individual barriers (limited competence in dementia, unrecognised autonomy, limited views on social health and quality of life (QoL)), hindering users access to dementia services.

Conclusion:

Enhanced competence in dementia, and nurse-led systematic care of people with dementia and their carers, are necessary. They can be effective in improving the QoL in dementia, but only if associated with better community support.

Network analysis approach for exploring dementia representations in the Slovak media

Objectives

The aim of the present study is to test the network analysis method on a corpus of media texts with the aim of systematically analysing media representations of dementia in the Slovak media.

Methods

A word-network was modelled from the corpus of media documents using social network analysis. 244 text-documents (web, print, TV and radio) from 2015 to 2018 (inclusive) were retrieved from the Newton media database using the search words ‘dementia’ and ‘Alzheimer’s disease’.

Results

Twelve clusters of co-occurring concepts corresponding to individual themes were identified. The results of the analysis provide evidence that biomedical themes such as ‘medical diagnosis’, ‘prevalence of dementia’ and ‘memory disorders’ possess the greatest representational strength and centrality and account for roughly two-thirds of the whole corpus.

Conclusion

Results of the present study provide valuable insights into the representation of dementia in the Slovak media but also demonstrate how media representations can be studied using the innovative approach of network analysis.

Do you look for information about dementia? Knowledge of cognitive impairment in older people among their relatives

Relatives and caregivers receive little information and have poor knowledge about cognitive impairment and dementia.

Development of the dementia community attitudes questionnaire

BACKGROUND

What it means to live with dementia is changing. Autonomy, independence and continued community involvement are now recognised goals. As a result, new initiatives are required to support people with dementia to sustain their quality of life, update community understanding and reflect resultant change in community attitudes. Measuring the impact of such initiatives can help determine the extent of their success, inform needs for further intervention and, ultimately, shape policy.

OBJECTIVE

To discover - or, if this could not be achieved, develop - a questionnaire measuring community attitudes towards people with dementia reflecting these newly recognised goals in terms of both content and expression.

METHODS

A four-stage approach was used in this research: a scoping review of the literature, questionnaire development and expert review, questionnaire piloting, including with people living with dementia and their families, and preliminary psychometric testing.

RESULTS

The review failed to retrieve a suitable existing questionnaire. A ten-item questionnaire, the Dementia Community Attitudes Questionnaire was developed, content validity was established by expert review and piloting led to refinements. Exploratory factor analysis (N = 92) generated an interpretable three-factor solution. Cronbach's alpha coefficient for Factor 1, Engagement, was good (0.855); for Factor 2, Challenges, and Factor 3, Decision-Making, reliability was acceptable (0.785 and 0.709, respectively).

CONCLUSION

Supporting people with dementia to sustain their quality of life requires new initiatives and suitable measures to evaluate their impact. The Dementia Community Attitudes Questionnaire was developed with input from people with dementia, their families, and relevant experts. Items reflect current opportunities for people with dementia to retain their independence, autonomy and community engagement for as long as possible. Following further psychometric testing, this new questionnaire may be useful to evaluate such initiatives.

Negative stereotypes, fear and social distance: a systematic review of depictions of dementia in popular culture in the context of stigma

BACKGROUND

Literature, film and news media reflect and shape social perceptions of dementia which in turn impact on dementia stigma. The aim of this paper is to systematically review papers on the depiction and frames for dementia in literature, film, mass media and social media in order to better understand cultural stigma related to dementia.

METHODS

A systematic search of electronic databases was undertaken combining phrases relating to dementia, popular culture and representations, and phrases relating to dementia and stigma. We searched for scientific English language papers which included original analysis on the representation or depiction of dementia in popular culture (i.e. in film and television, literature, news, social media and language). Articles published between 1989-2018 were included. The search was conducted in December 2017 and updated in January 2019. Inductive thematic synthesis was undertaken.

RESULTS

A total of 60 articles were included from an initial sample of 37022. Dementia was almost always depicted in conjunction with ageing, and often equated with Alzheimer's disease. Common frames for dementia were biomedical - dementia involves the deterioration of the brain for which there is no current cure; natural disaster or epidemic - dementia is a force of nature which will overwhelm mankind; and living dead - people with dementia lose their brains, memories, minds and consequently their personhood and human rights. There were examples of more positive depictions of dementia including expressing love and individual agency and experiencing personal growth. Feelings commonly associated with dementia were fear, shame, compassion and guilt, and depictions often resulted in a sense of social distance.

CONCLUSIONS

Depictions of dementia in popular culture are associated with negative images and feelings, and social distance between people with dementia and those without. These correspond to dementia stigma in the public and as experienced by people with dementia. Further research is needed into the impact of literature, news and social media on dementia stigma and these cultural mediums might be used to reduce stigma.

Effect of a dementia education intervention on the confidence and attitudes of general practitioners in Australia: a pretest post-test study

OBJECTIVES

This study assessed the impact of a Dementia Education Workshop on the confidence and attitudes of general practitioner (GP) registrars (GPR) and GP supervisors (GPS) in relation to the early diagnosis and management of dementia.

DESIGN

Pretest post-test research design.

SETTING

Continuing medical education in Australia.

PARTICIPANTS

332 GPR and 114 GPS.

INTERVENTIONS

Registrars participated in a 3-hour face-to-face workshop while supervisors participated in a 2-hour-modified version designed to assist with the education and supervision of registrars.

MAIN OUTCOME MEASURES

The General Practitioners Confidence and Attitude Scale for Dementia was used to assess overall confidence, attitude to care and engagement. A t-test for paired samples was used to identify differences from preworkshop (T1) to postworkshop (T2) for each GP group. A t-test for independent samples was undertaken to ascertain differences between each workshop group. A Cohen's d was calculated to measure the effect size of any difference between T1 and T2 scores.

RESULTS

Significant increases in scores were recorded for Confidence in Clinical Abilities, Attitude to Care and Engagement between pretest and post-test periods. GPR exhibited the greatest increase in scores for Confidence in Clinical Abilities and Engagement.

CONCLUSIONS

Targeted educational interventions can improve attitude, increase confidence and reduce negative attitudes towards engagement of participating GPs.

Giving Them a Voice: Challenges to Narrative Agency in People with Dementia

In this paper, we argue that the capacity for narrative agency is significantly compromised in individuals with dementia due to at least three factors: (a) Dementia itself, which causes increasing difficulties in constructing and articulating coherent and meaningful stories, and sharing them with others; (b) cultural narratives about dementia, which promote an extremely negative and pessimistic view of those with the disease; and (c) the convergence of these two last factors, which can lead to caregiving interactions that do not support storytelling and can even stop people with dementia from telling stories. We highlight the importance of narrative care, which involves interventions that focus on the person and their unique life narrative. In narrative care, people with dementia are treated not as impaired patients defined by the disease, but as human beings. In doing so, people with dementia can have their own voices back, which is silenced and discredited so many times.