Sources and perceptions of hope: A qualitative study involving younger people with dementia

Hope is an important but overlooked phenomenon in dementia studies. Few studies have examined how people with dementia experience or perceive hope, possibly because it is seen as a diagnosis without hope. In this article, we report on a doctoral study, the aim of which was to examine the phenomenon of hope from the perspective of younger people with dementia to generate new understanding and enable community-based healthcare professionals to support well-being. The study was conducted in the Midlands, England, and used a modified diary-interview method. Six participants were given a camera and asked to take pictures of whatever made them feel hopeful. During a post-diary semi-structured interview, a conversation about hope took place. Interviews were transcribed and interpreted using the 'Voice-Centred Relational Method'. Findings show that hope is important to younger people with dementia. Sources of hope were the surrounding environment, keeping connected, taking action, and drawing on internal resources. An over-arching theme was 'defying dementia' and participants demonstrated resistance to negative stereotypes. Living with dementia did not curtail hope, although it could be weakened when participants felt 'cast adrift' by services. The In vivo codes generated were fear of dementia, threats to identity, disconnection from others, and frustrations and restrictions. It is concluded that hope should be a more central part of practice-based conversations with people with dementia.

Learning and knowing technology as lived experience in people with Alzheimer's disease: a phenomenological study

OBJECTIVES

Most research on learning in the field of dementia has studied teaching approaches, while little is known about learning as experienced and enacted by the people with dementia. The aim was to explore the lived experience of learning and maintaining knowledge related to technology among people with mild to moderate stage dementia.

METHOD

Seven persons with dementia were interviewed in-depth, and data were analyzed with a phenomenological approach.

RESULTS

The participants positioned themselves on a continuum from 'Updating and expanding is not for me' to 'Updating and expanding is really for me'. They used different ways of learning in their everyday life - relying on one's habituated repertoire of actions, on other people or on technology itself, or belonging to a learning context.

CONCLUSIONS

We have much to gain from better understanding of how people with dementia strive to learn and maintain their skills and knowledge related to technology. This is particularly important as they seem to use other approaches than those employed in current teaching methods. The necessity of learning stands out particularly when it comes to the interaction with the current multitude and ever-changing designs of technologies, including assistive technologies developed specifically to support people with dementia.

Investigating poor insight in Alzheimer’s disease

Persons with Alzheimer’s disease (AD) often seem to have a poor insight into the functional deficits brought about by the dementing process. There are many indications that preserved insight into deficits in dementia is of advantage to a person with AD. Various research approaches have been adopted to investigate poor insight related to AD. The purpose of this article was to present various research approaches for investigating poor insight into deficits in AD. The study is based on a literature survey. The findings show that concept of poor insight has been investigated in detail from different perspectives. Each one of the perspectives found, the neuropsychological, the psychological and the socio-psychological, has its merits, but none of them has yet led to study results that make us fully understand what poor insight implies and involves. We need integrated knowledge from the different perspectives, and in multidisciplinary research settings we believe that such knowledge could be developed.

The development of memory difficulties

The primary focus of research exploring the experience of developing memory difficulties has been on people who already have a diagnosis of dementia. This study employs a qualitative approach to explore the experience of memory difficulties in three individuals experiencing the process of investigation for dementia. The participants were interviewed before they had a formal diagnosis, and again after they had attended for an assessment at a memory clinic. Partners' interviews provided a further interpretative context, although they were not analysed. Data were analysed using Interpretative Phenomenological Analysis. Results show that participants were keen to find an explanation for their memory difficulties. The satisfaction that participants felt with the explanation given at the memory clinic was dependent on how informed they felt, which also had implications for how they subsequently viewed themselves. Findings highlight the nature of uncertainty in the area of memory difficulties, and recommendations are discussed.

Living positively with dementia: a systematic review and synthesis of the qualitative literature

OBJECTIVE

Little is known about how and to what extent people with dementia live positively with their condition. This study aimed to review and carry out a synthesis of qualitative studies where accounts of the subjective experiences of people with dementia contained evidence of positive states, experiences or attributes.

METHODS

A meta-synthesis was undertaken to generate an integrated and interpretive account of the ability of people with dementia to have positive experiences. A methodological quality assessment was undertaken to maximize the reliability and validity of this synthesis and to contextualize the findings with regard to methodological constraints and epistemological concepts.

FINDINGS

Twenty-seven papers were included. Three super-ordinate themes relating to positive experiences and attributes were identified, each with varying and complementing sub-themes. The first super-ordinate theme related to the experience of engaging with life in ageing rather than explicitly to living with dementia. The second theme related to engaging with dementia itself and comprised the strengths that people can utilize in facing and fighting the condition. The third theme captured how people with dementia might transcend the condition and seek ways to maintain identity and even achieve personal growth.

CONCLUSIONS

This review provides a first step towards understanding what conceptual domains might be important in defining positive outcomes for people who live with dementia. Highlighting the potential for people to have positive experiences in spite of or even because of their dementia has important implications for de-stigmatizing dementia and will enhance person-centred approaches to care.

Managing Changes in Everyday Occupations: The Experience of Persons with Alzheimer's Disease

The aim of this study was to uncover how people with dementia respond to the problems and changes they experience in everyday occupations. Seven participants with dementia were included. Data were collected by means of repeated interviews and observations that focused on the person's experiences of competence and management in everyday occupations. The analysis was carried out from within a phenomenological perspective and resulted in a structure describing management strategies. It was concluded that the participants used a wide variety of strategies. Some strategies were directed toward managing the altered conditions caused by the disease while others served the purpose of responding to the occupational problems of everyday life. The latter strategies were of three types based mainly on environment, habituation, and cognition. Overall, the implicit and explicit cognitive awareness underpinning many strategies seems to call for great caution when assuming that people with dementia soon lose their awareness of disability.

Meanings and Motives for Engagement in Self-Chosen Daily Life Occupations among Individuals with Alzheimer's Disease

The aim of this study was to uncover and describe the meanings and motives for engagement in self-chosen daily life occupations for elderly individuals with Alzheimer's disease dwelling in the community. Six participants with Alzheimer's disease were included. Data were collected through repeated interviews and observations focusing on their motives for their self-chosen occupational engagement and the significance of the daily occupations. The analysis used a qualitative comparative and interpretative method. The findings show that the participants' occupations supported their ordinary pattern of everyday life and provided them with an opportunity to be in a coherent context. The occupations also allowed them to experience and communicate autonomy and certain characteristics of their identity and provided them with a private sphere. The findings revealed certain crucial but double-edged environmental keys to occupation. By identifying and supporting everyday occupations with personal meaning and value, therapists and caregivers may contribute to the well-being of individuals with Alzheimer's disease living in their own homes.

The Lived Experience of Memory Impairment in Daily Occupation after Acquired Brain Injury

The objective of this study was to identify what characterized the lived experience of memory impairment in daily occupations during the first year after acquired brain injury. Four participants were interviewed on four occasions during the year after the brain injury. The data were collected and analyzed using the Empirical Phenomenological Psychological method. The findings revealed four main characteristics that described the individual's experiences during the year of rehabilitation: a chaotic life-world, struggling for coherent doing in new contexts, conscious strategies in new contexts, and achieving new habits. After the brain injury, the life-world changed from a taken-for-granted existence to a chaotic world that was difficult to understand. The routine performance of daily activities and the habit patterns had broken down, so it was mostly the familiar activities that were already integrated in the “habit-body” that enabled coherent doings in everyday life during the year. The findings contribute to an understanding of how to use familiar and meaningful occupations as a therapeutic medium in the rehabilitation of clients with memory impairment following acquired brain injury.

Moments of homecoming among people with advanced dementia disease in a residential care facility

This study concerns moments of homecoming among people with advanced dementia disease living in a residential care facility. Our main finding from participant observations with nine residents was that the residents showed moments of homecoming, i.e. they alternated between verbal and/or nonverbal expressions of feeling at home and of not feeling at home. If care providers understand that they can help people with advanced dementia disease experience moments of homecoming, they can focus on aspects of care that can promote these experiences.

The effects of perceived stigma on quality of life outcomes in persons with early-stage dementia: Longitudinal findings: Part 2

This article is the second report from a study examining perceived stigma in persons with dementia with findings regarding the association between stigma and quality of life outcomes being reported here. Fifty persons with dementia and 47 family caregivers were sampled, with data being collected at baseline and six, 12, and 18 months. The modified Stigma Impact Scale measured perceived stigma. Quality of life outcomes included: depression, anxiety, behavioral symptoms, personal control, physical health, self-esteem, social support, and activity participation. Linear mixed model or generalized linear mixed model (for depression) analyses revealed that some aspect of perceived stigma was associated with each outcome. Social rejection was associated with anxiety, behavioral symptoms, health, and activity participation. Internalized shame was associated with anxiety, personal control, health, self-esteem, social support understanding and assistance, and activity participation. Finally, social isolation was associated with depression, anxiety, personal control, health, self-esteem, social support understanding, and activity participation. The complexity of relationships between perceived stigma and quality of life outcomes is evident from these findings.

Suffering caused by care-elderly patients' experiences in community care

Background

Growing old involves many changes in life and implies an increased risks of illness and different forms of disabilities. Life may change in a radical way when a person gets a disease like dementia or moves to a nursing home due to disabilities or needs. In both cases, it often leads to an increased dependency on care where the patient becomes exposed and vulnerable and thereby at a higher risk for experiencing different forms of suffering.

Aim

The aim of this study was to elucidate and gain a deeper understanding of elderly patients’ experiences of suffering in relation to community care in nursing homes and home care services.

Materials and methods

A lifeworld hermeneutical approach was used. Phenomenological interviews and conversations with an open approach were conducted and analysed with a focus on meanings.

Findings

The findings were presented in four main themes; an absence of the other in care, an absence of dialogues, a sense of alienation and a sense of insecurity. The findings in this study revealed that persons who were cared for in nursing homes and home care services sometimes were exposed to an unnecessary suffering. The suffering sometimes was caused by various caring actions, that is, unnecessary suffering. The suffering caused by care that aroused was due to caregiver’s inability to be present, to show their face, and truly meet the patient.

Conclusion

Suffering from care increased the elderly patients’ feelings of insecurity, loneliness, and alienation; this seemed to be the foundation for patients’ experiences of being outside a human community. There was a lack of knowledge and understanding about the patient’s lifeworld.

Gradually losing one's foothold--a fragmented existence when living alone with dementia

The number of persons with dementia who lives at home for a longer period of time after diagnosis is increasing. Even if the literature in the dementia field is growing, there is a need for more knowledge about everyday life of persons with a dementia disease; particularly the lived perspective of persons who live alone. The aim of this study was to elucidate the phenomenon of living alone with dementia and having a manifest care need. This phenomenological study was carried out from a reflective lifeworld approach. The data material in the study consisted of field notes from 32 visits and transcriptions from 11 tape-recorded conversations with six participants. The results reveal that the person with dementia who lives alone ends up in a vague existence where they cannot survive alone. The person's level of activity comes to a halt and body movement becomes slower. Daily life becomes more difficult to manage and the person's earlier natural way of relating to the world and the people around them is gradually lost. This is followed by a loneliness and forgetfulness that cloud the meaning of life. This study highlights the importance of the patient's perspective needed to better understand the inner life of a person who suffers from dementia. This understanding is important in the organization of help and care as well as for caregivers to better understand these individuals and their needs.

Psychosocial factors that shape patient and carer experiences of dementia diagnosis and treatment: a systematic review of qualitative studies

BACKGROUND

Early diagnosis and intervention for people with dementia is increasingly considered a priority, but practitioners are concerned with the effects of earlier diagnosis and interventions on patients and caregivers. This systematic review evaluates the qualitative evidence about how people accommodate and adapt to the diagnosis of dementia and its immediate consequences, to guide practice.

METHODS AND FINDINGS

We systematically reviewed qualitative studies exploring experiences of community-dwelling individuals with dementia, and their carers, around diagnosis and the transition to becoming a person with dementia. We searched PubMed, PsychINFO, Embase, CINAHL, and the British Nursing Index (all searched in May 2010 with no date restrictions; PubMed search updated in February 2012), checked reference lists, and undertook citation searches in PubMed and Google Scholar (ongoing to September 2011). We used thematic synthesis to identify key themes, commonalities, barriers to earlier diagnosis, and support identified as helpful. We identified 126 papers reporting 102 studies including a total of 3,095 participants. Three overarching themes emerged from our analysis: (1) pathways through diagnosis, including its impact on identity, roles, and relationships; (2) resolving conflicts to accommodate a diagnosis, including the acceptability of support, focusing on the present or the future, and the use or avoidance of knowledge; and (3) strategies and support to minimise the impact of dementia. Consistent barriers to diagnosis include stigma, normalisation of symptoms, and lack of knowledge. Studies report a lack of specialist support particularly post-diagnosis.

CONCLUSIONS

There is an extensive body of qualitative literature on the experiences of community-dwelling individuals with dementia on receiving and adapting to a diagnosis of dementia. We present a thematic analysis that could be useful to professionals working with people with dementia. We suggest that research emphasis should shift towards the development and evaluation of interventions, particularly those providing support after diagnosis.

Managing identity in early-stage dementia: maintaining a sense of being valued

Focusing on loss or maintenance of identity in persons with dementia may affect how they are approached and cared for. We performed a longitudinal study of 17 elderly persons with early-stage dementia with the aim of exploring changes in the experience of living with dementia. The major theme – a struggle to be valued – was clearly present in follow-up interviews. However, we observed a gradual shift in the concept of being valued: a shift from ‘being valued for what you do’ toward ‘being valued for who you are’. This progression represents a shift from performance-related core values of identity to those that are existentially related. These findings suggest that the self can be maintained by adjusting to loss.

Living with a person with Alzheimer's disease: Experiences related to everyday occupations

The aim of this study was to illuminate experiences of daily occupations among spouses living with a person with Alzheimer's disease (AD). The study contains phenomenological-hermeneutic interpretation of interviews with eight spouses. The analysis revealed the participants as being in the process of a changing occupational situation. They come to live an occupational life intertwined with their partners' needs. An ongoing process of occupational adjustment is taking place as a response to the changing situation. The spouses were occupied with consequences of their partner's disease. They were striving for occupational meaning and at the same time living with threats to meaningful occupations. It can be concluded that living with a partner with AD is a complex dealing with occupational meaning. This complexity should be considered in interventions.

Access technology and dementia care: Influences on residents’ everyday lives in a secure unit

There is a need to understand how technology can best be used to facilitate well-being in people with dementia. This study sought to describe how access control technology influenced the everyday lives of people with dementia living in a secure unit. The staff members and the unit's residents participated in the study. Data were collected through ethnographic observations and semi-structured interviews over 6 months, and were analyzed using the constant comparative method. The results show how access technology supported the residents' sense of security, territoriality, orientation, and adaptation to the environment. However, certain conditions were necessary for these influences to appear. Overall, the results indicate that access control technology may be used to support the well-being of people with dementia, and to increase their opportunities to feel in place in a secure unit. However, there is an urgent need in the future for further exploration of the conditions for use of technology in the field of dementia care, and the necessity of making careful evaluations of the use of technology in this field cannot be overemphasized.

How can we get access to the experiences of people with dementia?

This paper suggests and discusses a methodological approach that aims to facilitate the inclusion of people with dementia in research where the ambition is to better understand their experiences. People with dementia have commonly not been included as informants in research as their cognitive deficits have been regarded as a hindrance. Moreover, in the qualitative research tradition, most inquiries rely on data obtained from interviews, thereby requiring communication and verbal skills, which are skills that are affected early in the cause of dementia. Consequently, the considerably under-researched area of how dementia is experienced and managed from the perspective of those afflicted has long been put aside. This paper suggests that a combination of qualitative observations and adapted interviews may make it possible for people with dementia to participate as research informants. Issues concerned with creating a relationship with informants with dementia and helping them to elicit their experiences are elaborated and discussed. Some suggestions are made concerning how the context can be used for this intent, and how the observations and interviews can be adapted to the informants with dementia.

Awareness through interaction in everyday occupations: Experiences of people with Alzheimer's disease

The aim of this study was to explore and describe the characteristics of awareness of the consequences of having Alzheimer's disease on everyday life occupations. Six community-dwelling participants with Alzheimer's disease were interviewed on repeated occasions about their lived experiences of everyday occupations. A phenomenological method was adopted for the analysis. The findings show that the participants discovered and explored the changes in how they performed everyday occupations in the context of their social relations and through immediate reflections on their forgetfulness. They attempted to handle the changes by adapting their behaviour. Awareness of the changes in their lives was evident in their reflections, as they tried to make sense of what was happening to them. This seemed to be related to an elusive perception of change in situations that they found impossible to influence. The participants reflected on the impact their condition had on other people near them. Their reflections also involved emotional reactions to the shortcomings they experienced. In conclusion, the findings show how these people with Alzheimer's disease were able to express awareness of the consequences of their illness through their reflections on their experiences of interaction with the occupations and the social environment.

The meaning of everyday technology as experienced by people with dementia who live alone

This study explored how people with dementia who live alone experienced the meaning of their everyday technology, such as telephones and electronic equipment, and the use of it. Eight participants with mild to moderate stage dementia were included. Repeated interviews and observations were undertaken in each participant's home and surroundings. A phenomenological, interpretative method was adopted in the analysis. In summary, the participants experienced their everyday technology to be embedded with both practical and existential meaning, as it could assist them in different ways in daily life as well as support their perception and presentation of themselves. Although important, habit and familiarity did not seem to provide them with enough support to continue using technology, unless the technology was experienced as very significant and incorporated in a bodily experience through continuous and very frequent practice. The abundance of experienced meanings and the significance of the technology in the participants' lives call for further studies in order to better understand the conditions for managing everyday technology in home and society and, when relevant, to facilitate technology use in people with dementia.

Technology Studies to Meet the Needs of People With Dementia and Their Caregivers

The aim of this article is to present the findings of a review of studies that focused on technology supporting people with dementia and their caregivers. A literature search was carried out in eight scientific literature databases covering literature published between January 1992 and February 2007. A total of 46 studies providing original data and one review were included in this review. Analyses covered the aims of the studies, the technology used, study design, methods, outcome variables, and results. Most studies were carried out in residential care and focused on the needs of formal caregivers. Only a few studies involved people with dementia actively using the technology. The studies are difficult to compare because of the large variety of aims, technologies, design, and outcome measurements. There is a need for more research in this area, in particular, with people who have a mild stage dementia living in the community.

Living with dementia from the perspective of older people: is it a positive story?

Dementia, even at an early stage, may pose problems and challenge one's quality of life. Having accurate knowledge of what one experiences when living with dementia is important for developing proactive care for individuals with dementia and their families. The aim of our Grounded Theory study was to explore what it means for elderly people to live with early-stage dementia. We interviewed 20 elderly people with probable mild dementia and their family members. Living with dementia was often presented as a positive narrative, one that told of only minor problems and which stressed abilities and contentment with life. Being valued, rather than losing one's cognition or identity was central in their experience. More in-depth analyses of participants' narratives revealed, however, that they were constantly balancing their feelings of value and worthlessness, struggling to remain someone of value. This struggle was prompted by threats posed by dementia and by the persons' interactions with others. Superficially, a positive narrative may be understood as a lack of awareness or as denial due to cognitive loss. Our findings suggest, however, that we should look beyond this superficial view and seek to understand the narrative as an expression of one's attempt to counterbalance devaluation.

The use of everyday technology by people with dementia living alone: mapping out the difficulties

While the technological development available to society is taking quantum leaps, we have little knowledge of how people with mild dementia manage to cope with familiar technology at home, such as television and electronic household machines, or new technology, such as remote controls, cell phones and computers. As this technology represents a potential problem area, the aim of this qualitative, exploratory study was to identify and characterize difficulties with and hindrances to using everyday technology, as they appeared in data, for persons with early stage dementia. Eight participants with dementia were included in an extensive data collection consisting of repeated interviews and observations made in the home; the data were analyzed adopting a constant comparative approach. The results exhibit a taxonomy of difficulties in four domains, encompassing conditions that interfere with the use of the technology, deficiencies in knowledge and in the communication between users and their technology, and limitations in the use of instructions. Typically, difficulties appeared in complex combinations. They arose when familiar technology was being used, and not only when new technology was to be used. This raised concerns about the need these people have for support in home and in society. Further research is needed to validate the findings.

Reframing Person-Centered Nursing Care for Persons With Dementia

Alzheimer’s dementia manifests in a complex clinical presentation that has been addressed from both biomedical and phenomenological perspectives. Although each of these paradigmatic perspectives has contributed to advancement of the science, neither is adequate for theoretically framing a person-centered approach to nursing care. The need-driven dementia-compromised behavior (NDB) model is discussed as an exemplar of midrange nursing theory that promotes the integration of these paradigmatic views to promote a new level of excellence in person-centered dementia care. Clinical application of the NDB promotes a new level of praxis, or thoughtful action, in the care of persons with dementia.

Conducting qualitative interview research with people with expressive language difficulties

Despite the increasing application of qualitative interviewing and analysis approaches, individuals with expressive language difficulties are still frequently excluded from such research. In this article, the authors seek to clarify the role for and importance of conducting qualitative interviews with respondents with impaired expressive language. They review current research with reference to studies conducted with individuals with intellectual disabilities or dementia, or those who have experienced stroke or traumatic brain injury, and identify deficits within existing research. They consider the challenges and difficulties that contribute to the limited inclusion of individuals with impaired expressive communication in qualitative interviews and discuss the way forward with suggestions of possible means of overcoming these obstacles. They argue that a willingness to adapt methods appropriately and to modify expectations is an important factor in ensuring that researchers hear the voice of respondents with expressive language deficits.

Living with early-stage dementia: a review of qualitative studies

AIM

This paper presents a literature review whose aim was to provide better understanding of living with early-stage dementia.

BACKGROUND

Even in the early stages, dementia may challenge quality of life. Research on early-stage dementia is mainly in the domain of biomedical aetiology and pathology, providing little understanding of what it means to live with dementia. Knowledge of the lived experience of having dementia is important in order to focus pro-active care towards enhancing quality of life. Qualitative research is fundamentally well suited to obtaining an insider's view of living with early-stage dementia.

METHOD

We performed a meta-synthesis of qualitative research findings. We searched MEDLINE, CINAHL, and PsycINFO and reviewed the papers cited in the references of pertinent articles, the references cited in a recently published book on the subjective experience of dementia, one thesis, and the journal Dementia. Thirty-three pertinent articles were identified, representing 28 separate studies and 21 different research samples. Findings were coded, grouped, compared and integrated.

FINDINGS

Living with dementia is described from the stage a person discovers the memory impairment, through the stage of being diagnosed with dementia, to that of the person's attempts to integrate the impairment into everyday life. Memory loss often threatens perceptions of security, autonomy and being a meaningful member of society. At early stages of memory loss, individuals use self-protecting and self-adjusting strategies to deal with perceived changes and threats. However, the memory impairment itself may make it difficult for an individual to deal with these changes, thereby causing frustration, uncertainty and fear.

CONCLUSIONS

Our analysis supports the integration of proactive care into the diagnostic process, because even early-stage dementia may challenge quality of life. Moreover, this care should actively involve both the individual with dementia and their family so that both parties can adjust positively to living with dementia.

The intimate mediator: a carer's experience of Alzheimer's

This research arose out of a collaboration between a service user (M) and two researchers. Following M's invitation to us to explore issues surrounding a carer's experience of Alzheimer's, we jointly agreed a research strategy in which we would engage in a series of interviews with M, with the aim of developing insight into how the intimate carer's complex journey can support and benefit other family caregivers faced with similar challenges. Using a broadly hermeneutic-phenomenological method, three essential themes emerged to describe the carer's journey: (i) something is wrong; (ii) the challenging shared journey: being the carer; (iii) coping through meaning-making: advocacy. We arrive at a position which considers the unique role of an intimate carer as a 'liminal' figure between the private world of an Alzheimer's sufferer and the public world of health and social care systems. The paper concludes with a consideration of how the unique role of the intimate carer as mediator could be more respectfully involved as an ongoing knowledge source for care planning and treatment decisions. Specific areas of consideration in this regard include mechanisms for such user involvement in policy making, day-to-day care delivery, and developments in the support of other carers. We hope to highlight the 'intimacy' of this position and the distinctive benefits and challenges of such intimacy in providing a crucial level of user knowledge and 'evidence' for ongoing treatment decisions. We also hope to highlight the value and power of single-case study in generating useful insights for practice.

Telephone use among noninstitutionalized persons with dementia living alone: mapping out difficulties and response strategies

The aim of this study was to map out and describe difficulties and response strategies in telephone use among elderly, noninstitutionalized persons with dementia living alone. To obtain explorative data, interviews and observations in the homes were undertaken with 10 participants diagnosed with dementia. The participants were observed when showing their telephones, calling a well-known number, responding to a request previously sent by letter to make a telephone call, and finding a number in the telephone directories. The data were analysed using a comparative approach, and resulted in descriptive categories. The participants' difficulties were categorized as difficulty in 'knowing what', 'knowing where', 'knowing how' and overcoming motor, perceptual, verbal and environmental obstacles. In responding to these, they used a variety of environmentally related strategies such as using perception or habits and habitual places, verbalizing aloud, seeking help from others, and adjusting the physical environment. They also used a few cognitively related strategies such as repeating and stopping and reflecting. Overall, difficulties were frequent and common, and the effectiveness of the strategies was questionable. The results indicate that it might be unrealistic to assume that elderly persons with symptoms of dementia who live alone are able to satisfactorily use the telephone for safety, communication and participation in society.

Temporary confusion: a fearful experience

Older people admitted to hospital often develop acute temporary confusion. Earlier studies have focused on problems in providing care to the confused, causes of the confusion and the key aspects of caring. The aims of this study were to describe, from a nursing perspective, how older people experienced the phenomenon of temporary confusion and to describe the older peoples' reasoning when they described their experiences. Interviews with five older informants who had recovered from their confusional state were conducted and analysed using the phenomenological method. Two phenomena were studied, 'being temporarily confused' and 'reasoning about experiences of temporary confusion', each was found to be represented by four inter-related constituents. The phenomena can be understood as aspects of suffering and power imbalance between staff and older people.