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Huizenga J, Scheffelaar A, Bleijenberg N, Wilken JP, Keady J, Van Regenmortel T. What matters most: Exploring the everyday lives of people with dementia. Int J Geriatr Psychiatry 2023; 38:e5983. [PMID: 37565538 DOI: 10.1002/gps.5983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Research on what matters most to people with dementia is crucial for developing tailored interventions and support. This study explored how people with dementia experience their everyday lives, providing insight into what is important to them to live the best they can at home. METHODS Inspired by a phenomenological approach, open interviews were conducted with 15 people with dementia, supplemented by home tours and walking interviews. Data collection included one to three sessions per participant. Data were analysed using descriptive content analysis and followed the phases of open, axial, and selective coding. A co-researcher group of seven people with dementia was consulted during the analysis to help interpret the emergent findings. FINDINGS Six dimensions of what matters most in everyday life were identified: 1) Engaging in meaningful activities, which included routines, household chores, leisure, day activities, and volunteering or work; 2) Keeping a sense of connection, in relationships within the home, with family, friends, groups, and the neighbourhood; 3) Having a sense of belonging, which included attachments inside and outside the home, and to cherished objects; 4) Connecting to self, which included the ability to reflect on past experiences, live in the present moment and anticipate the future; 5) Adjusting to ongoing changes, which included alterations in sensory perceptions, perceptions of the physical environment, and navigating shifts in interpersonal dynamics; 6) Being open to help and support, from professionals, community and society. CONCLUSIONS For people with dementia, everyday life is a continuous balancing act between what matters most and what can be achieved daily. This is not only related to dementia but is also embedded in the wider perspective of life history, relational networks, and the physical environment. This study highlights the importance of identifying what matters most to people with dementia to provide person-centred support.
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Affiliation(s)
- Jacoba Huizenga
- Institute of Social Work, HU University of Applied Sciences, Utrecht, The Netherlands
- Research Center Social Innovation, HU University of Applied Sciences, Utrecht, The Netherlands
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Aukelien Scheffelaar
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Nienke Bleijenberg
- Research Center Healthy & Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
- Department Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jean Pierre Wilken
- Research Center Social Innovation, HU University of Applied Sciences, Utrecht, The Netherlands
| | - John Keady
- Division of Nursing, Midwifery and Social Work/Greater Manchester Mental Health NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Tine Van Regenmortel
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- HIVA-Research Institute for Work and Society, Faculty of Social Sciences, University of Leuven, Leuven, Belgium
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Getting lost with dementia: Encounters with the time-space of not knowing. Health Place 2022; 78:102940. [DOI: 10.1016/j.healthplace.2022.102940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/05/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
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Dreyer J, Bergmann JM, Köhler K, Hochgraeber I, Pinkert C, Roes M, Thyrian JR, Wiegelmann H, Holle B. Differences and commonalities of home-based care arrangements for persons living with dementia in Germany - a theory-driven development of types using multiple correspondence analysis and hierarchical cluster analysis. BMC Geriatr 2022; 22:723. [PMID: 36050645 PMCID: PMC9438141 DOI: 10.1186/s12877-022-03310-1] [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: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most persons with dementia live at home and want to stay there as long as possible. In most cases, informal carers such as spouses or children care for them. Together with other family members and professional carers, they form care arrangements to address the complex needs of persons with dementia. One major aim of informal carers is to keep the care arrangement stable. The middle-range theory of 'stability of home-based care arrangements for people living with dementia' (SoCA-Dem theory) offers a theory to understand what constitutes and influences the stability of home-based care arrangements. Based on this theory, the aim of this study was to (1) uncover the underlying structures of differences and commonalities of home-based care arrangements for persons living with dementia, (2) construct types of these care arrangements, and (3) compare these types with regard to their stability. METHOD This is a secondary analysis of data from a convenience sample of n = 320 care arrangements for persons with dementia obtained in the observational DemNet-D study. Data were analysed using multiple correspondence analysis and hierarchical cluster analysis. Sociodemographic data and variables related to the structure of the care arrangement (D-IVA), burden of the informal carer (BICS-D), dementia severity (FAST), and quality of life of the person with dementia (QOL-AD) were included. RESULTS The multiple correspondence analysis identified 27 axes that explained the entire variance between all care arrangements. The two axes 'dementia and care trajectory' and 'structure of the dyadic relationship' best distinguished care arrangements from each other and together explained 27.10% of the variance. The subsequent cluster analysis identified four types of care arrangements. Two types included spouse-centred care arrangements, and two types included child-centred care arrangements at different phases of the dementia and care trajectory. The types differ with regard to their stability. CONCLUSION The results highlight the heterogeneity and commonality of care arrangements for persons living with dementia. They contribute to a better understanding of informal dementia home care. Furthermore, the results can guide the development of tailored support for persons living with dementia and their caring families.
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Affiliation(s)
- Jan Dreyer
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany.
| | | | - Kerstin Köhler
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Iris Hochgraeber
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Christiane Pinkert
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Henrik Wiegelmann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
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Huizenga J, Scheffelaar A, Fruijtier A, Wilken JP, Bleijenberg N, Van Regenmortel T. Everyday Experiences of People Living with Mild Cognitive Impairment or Dementia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10828. [PMID: 36078544 PMCID: PMC9518176 DOI: 10.3390/ijerph191710828] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Increasing attention has been paid to the 'voice' of people living with mild cognitive impairment (MCI) or dementia, but there is a lack of clarity about how everyday life is perceived from this insider's perspective. This study aimed to explore the everyday life experiences, challenges and facilitators of individuals with MCI and dementia living at home. A scoping review of qualitative studies, guided by the Joanna Briggs Institute Reviewers Manual, was conducted. Eight databases were searched, resulting in 6345 records, of which 58 papers published between 2011 and 2021 were included. Analysis was carried out by descriptive content analysis. Findings were categorized into seven spheres of everyday life: experiences related to the condition, self, relationships, activities, environment, health and social care and public opinions. The results show many disruptions and losses in everyday life and how people try to accommodate these changes. In all areas of everyday life, people show a deep desire to have reciprocal relationships, stay engaged through participation in activities and have a sense of belonging in the community. However, more research is needed on the factors that promote and impede the sense of reciprocity and belonging.
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Affiliation(s)
- Jacoba Huizenga
- Institute of Social Work, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Aukelien Scheffelaar
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Agnetha Fruijtier
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
| | - Jean Pierre Wilken
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Research Center Healthy & Sustainable Living, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Department Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Tine Van Regenmortel
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
- HIVA—Research Institute for Work and Society, Faculty of Social Sciences, University of Leuven, B-3000 Leuven, Belgium
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Abstract
Seeking to support qualitative researchers in the artful development of feminist care scholarship, our goal here is to ‘look back’ on how we have conceptualized the problems of care and developed research that illuminates the social organization of care in distinct ways. As part of a ‘feminist care scholar retrospective’, we present five condensed ‘reverse research proposals’, which are retrospective accounts of past research or scholarly activity. From there, we discuss how each project begins with a particular problematic for investigation and a particular conception of care (e.g., as practices, as work, as a concept) to illuminate facets of the social organization of care shaping paid and unpaid care work and its interpretations. These approaches reveal multiple and overlapping ways that care is embodied, understood and organized, as well as ways care can be transformed.
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Judge H, Ceci C. Problematising assumptions about 'centredness' in patient and family centred care research in acute care settings. Nurs Inq 2021; 29:e12448. [PMID: 34453480 DOI: 10.1111/nin.12448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022]
Abstract
Over the last two decades significant efforts have been made to implement patient and family 'centred' care as both a practical and moral imperative for adult acute care delivery. Although many resources have been developed and adopted by institutions, research suggests persistent and diverse barriers to implementing and achieving patient and family 'centred' care in adult acute care practice settings. These issues in implementation suggest re-examining the nature of 'centredness' in care may be useful. A structured problematisation method, as outlined by Alvesson and Sandberg, is utilised to identify and analyse assumptions about the central notions of 'centring' that inform patient and family centred care intervention research. From our analysis, we highlight three predominant areas within 'centring' intervention research that may benefit from rethinking: Vitruvian spatiality, democratising care, and 'centring' positioned as primarily a problem and accomplishment for nursing. As a challenge to these assumptions, we argue for the adoption of theoretical lenses that 'de-centre' individual actors to better account for complex relations among multiple actors, both human and nonhuman, which work to involve patients and families in care practices.
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Affiliation(s)
- Harkeert Judge
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Christine Ceci
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Gudnadottir M, Ceci C, Kirkevold M, Björnsdóttir K. Community-based dementia care re-defined: Lessons from Iceland. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1091-1099. [PMID: 32885543 DOI: 10.1111/hsc.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/26/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
Studies of families caring for persons with dementia living at home often reflect feelings of being forgotten and abandoned by the authorities to shoulder the responsibility for care-giving. This has increased interest in how formal services can better support these families. This article analyses how health and social care professionals envision the needs of families of persons with dementia living in the community. It also describes the contributions of the formal care system to these families. The study design was qualitative. It involved interviews with professionals (N = 20), field observations from the settings where they worked, and public documents addressing care-giving for people with dementia. Data were analysed using the framework method. The findings reflected how those providing services to persons experiencing cognitive changes mainly understood the services as specialised. They focused on the diagnosis and treatment of the individual with dementia. They considered other aspects of care, such as attending to practical issues of daily life, to be a private matter, for which the family was responsible. In later stages of dementia, specialised day programs become available, offering rehabilitation to motivate positive daily living-for both the person experiencing dementia and family-centred supporters. Professionals in the field described primary care, community-based healthcare and home care services as poorly equipped to support these families. Participants acknowledged that families were often under a lot of stress and might need more support earlier in the illness. However, they saw themselves as powerless. Towards the end of the data collection, services were being re-designed to emphasise the role of primary care. In light of its holistic and family-centred approach, primary care may be well placed to integrate relational understanding of living with dementia and specialised knowledge of dementia treatment.
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Affiliation(s)
| | - Christine Ceci
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Marit Kirkevold
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Köhler K, Dreyer J, Hochgraeber I, von Kutzleben M, Pinkert C, Roes M, Holle B. Towards a middle-range theory of 'Stability of home-based care arrangements for people living with dementia' (SoCA-Dem): findings from a meta-study on mixed research. BMJ Open 2021; 11:e042515. [PMID: 33853798 PMCID: PMC8054086 DOI: 10.1136/bmjopen-2020-042515] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Most people with dementia and their informal carers live at home and strive to create a stable care situation for as long as possible. This preference of dyads is consistent with the global policy of ageing in place. Therefore, we aimed to develop a middle-range theory of stability guided by two research questions: How is stability of home-based care arrangements for people living with dementia constituted? What are the essential factors influencing stability? METHODS Within the 'Stability of home-based care arrangements for people living with dementia' project (SoCA project) at the German Center for Neurodegenerative Diseases (DZNE), we conducted a meta-study on mixed research. The analytical steps of meta-data analysis, meta-method and meta-theory are merged in an integrative synthesis. Eligible publications were identified through systematic database searches (MEDLINE, CINAHL and PsycINFO; last searched on 3 January 2017), backward/forward citation tracking and snowballing. All publications were screened against predefined inclusion criteria and evaluated through a quality appraisal. The analytical approach was thematic synthesis. RESULTS 99 publications were included. The middle-range theory conceptualises stability as a complex phenomenon comprising three components including eight concepts that are dynamically inter-related. The conceptual model visualises: (1) the trajectory of the dementia care arrangement, which involves a cyclic process of change and balancing over time; (2) the characteristics of the care arrangement, including needs, the carer role, the dyadic relationship and resources; and (3) the context, which is determined by society and culture and the respective healthcare system. The relevance of each concept in relation to stability changes over time. The forming of each concept is actively shaped by the informal carer. DISCUSSION This middle-range theory provides a thorough understanding of the stability of home-based care arrangements for people living with dementia and can be used to guide future research and practice. OTHER This meta-study was funded by the DZNE and registered in PROSPERO (registration number CRD42016041727).
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Affiliation(s)
- Kerstin Köhler
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Jan Dreyer
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Iris Hochgraeber
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Milena von Kutzleben
- Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Christiane Pinkert
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Martina Roes
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
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Dementia trials, outcomes, and outcome measurement instruments for people living with dementia and family carers - considerations on how to improve the "gold standard". Int Psychogeriatr 2021; 33:327-330. [PMID: 33970067 DOI: 10.1017/s1041610220003749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Akhter-Khan SC, Au R. Why Loneliness Interventions Are Unsuccessful: A Call for Precision Health. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2020; 2:e200016. [PMID: 36037052 PMCID: PMC9410567 DOI: 10.20900/agmr20200016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Background Loneliness has drawn increasing attention over the past few decades due to rising recognition of its close connection with serious health issues, like dementia. Yet, researchers are failing to find solutions to alleviate the globally experienced burden of loneliness. Purpose This review aims to shed light on possible reasons for why interventions have been ineffective. We suggest new directions for research on loneliness as it relates to precision health, emerging technologies, digital phenotyping, and machine learning. Results Current loneliness interventions are unsuccessful due to (i) their inconsideration of loneliness as a heterogeneous construct and (ii) not being targeted at individuals' needs and contexts. We propose a model for how loneliness interventions can move towards finding the right solution for the right person at the right time. Taking a precision health approach, we explore how transdisciplinary research can contribute to creating a more holistic picture of loneliness and shift interventions from treatment to prevention. Conclusions We urge the field to rethink metrics to account for diverse intra-individual experiences and trajectories of loneliness. Big data sharing and evolving technologies that emphasize human connection raise hope for realizing our model of precision health applied to loneliness. There is an urgent need for precise, integrated, and theory-driven interventions that focus on individuals' needs and the subjective burden of loneliness in the ageing context.
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Affiliation(s)
- Samia C. Akhter-Khan
- Department of Psychology, Humboldt University of Berlin, 10117 Berlin, Germany
- Department of Psychology & Neuroscience, Duke University Graduate School, NC 27705, USA
| | - Rhoda Au
- Departments of Anatomy & Neurobiology and Neurology, Boston University Alzheimer’s Disease Center, Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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