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Warren A. The relationship between perceived stigma and perceived stress in cognitive decline: a survey of persons with mild cognitive impairment and their caregivers. Front Psychol 2023; 14:1293284. [PMID: 38144994 PMCID: PMC10740212 DOI: 10.3389/fpsyg.2023.1293284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction While Alzheimer's disease and other causes of dementia have rapidly become a global health crisis with growing incidence that is unabated, the incidence of Mild Cognitive Impairment (MCI) far exceeds that of Alzheimer's disease. Persons with MCI demonstrate some level of cognitive impairment, but daily functions remain intact and there is no certainty that they will develop dementia. Yet, the possibility conjures a considerable amount of fear and anxiety, further fueled by a vast array of misconceptions and stigma. The pervasive nature of this stigma permeates society and culture at many levels. Persons with MCI who are at higher risk for development of dementia may be especially vulnerable to fear and stigma associated with the diagnosis. Based on this premise, the primary aim of this study was to examine the relationship between perceived stigma and perceived stress in persons with MCI and their care partners, including the relationship between income and the study variables. The secondary aim was to examine the effect of a combined cognitive rehabilitation and wellness program on these perceptions. Methods Thirty participants were recruited from Mayo Clinic's Health Action to Benefit Independence and Thinking (HABIT) program. MCI (n = 15) and care partner (n = 15) participants completed the Stigma Impact Scale (SIS) and the Perceived Stress Scale (PSS) before and after the HABIT program. Results Average SIS and PSS scores decreased in the MCI, care partner, and combined groups, both pre- and post-HABIT. Linear regression was used to assess the relationship between perceived stigma and stress, controlling for income. A significant relationship was found between perceived stigma and perceived stress both pre and post-HABIT. Discussion The results suggest a relationship exists between perceived stigma and perceived stress in persons with MCI and their care partners, and an educational program such as HABIT may strengthen this relationship by informing participants of potential challenges that occur in cognitive decline. Understanding these relationships may provide an opportunity to provide tools for this vulnerable population.
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Affiliation(s)
- Alison Warren
- The Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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Gadbois EA, Bélanger E, Shield RR, Plassman BL, Van Houtven CH, Wetle TF. "Now at least we have something to call it": Patient and care partner experiences receiving an amyloid PET scan. J Am Geriatr Soc 2022; 70:2938-2947. [PMID: 35833618 PMCID: PMC10028617 DOI: 10.1111/jgs.17937] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/29/2022] [Accepted: 05/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The primary objective of this paper was to examine perspectives and experiences of individuals with cognitive impairment who received an amyloid PET scan and their care partners, with regard to the process, logistics, and decision-making associated with receiving an amyloid PET scan and its results. METHODS Structured telephone interviews were conducted with 200 randomly sampled scan recipient/care partner dyads from the CARE IDEAS study. The audio-recorded, transcribed responses were analyzed using an inductive qualitative content analytic approach. RESULTS Participating individuals and care partners described their experiences in seeking a diagnosis for memory issues, including decision-making and logistics involved with receiving an amyloid PET scan. Participants discussed the factors contributing to their decision to seek a diagnosis for their memory issues and their hopes and expectations in completing the scan. Participants also described the trajectory of this process, and although some described relatively straightforward trajectories, others described problems associated with identifying appropriate providers and coordinating care across numerous providers to obtain a diagnosis for their memory issues. Participants described an additional challenge of physicians attributing cognitive decline to normal aging, rather than signs of a neurodegenerative disorder. CONCLUSIONS Findings shed light on the barriers and delays that individuals and care partners experience in connecting with physicians and obtaining a comprehensive evaluation for cognitive problems. Results from this study have implications for physicians who provide care to older adults, and specifically highlight the need for greater care coordination and clearer communication with and systems of referral for patients.
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Affiliation(s)
- Emily A. Gadbois
- Brown University School of Public Health, Department of Health Services, Policy, and Practice and Center for Gerontology and Healthcare Research
| | - Emmanuelle Bélanger
- Brown University School of Public Health, Department of Health Services, Policy, and Practice and Center for Gerontology and Healthcare Research
| | - Renee R. Shield
- Brown University School of Public Health, Department of Health Services, Policy, and Practice and Center for Gerontology and Healthcare Research
| | - Brenda L. Plassman
- Duke University School of Medicine, Departments of Psychiatry and Neurology
| | - Courtney H. Van Houtven
- Durham VA Health Care System
- Duke University, Department of Population Health Sciences
- Duke-Margolis Center for Health Policy
| | - Terrie Fox Wetle
- Brown University School of Public Health, Department of Health Services, Policy, and Practice and Center for Gerontology and Healthcare Research
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Lu Y, Liu C, Yu D, Wells Y. Conditions required to ensure successful detection and management of mild cognitive impairment in primary care: A Delphi consultation study in China. Front Public Health 2022; 10:943964. [PMID: 36211650 PMCID: PMC9540221 DOI: 10.3389/fpubh.2022.943964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023] Open
Abstract
Objective Detection and management of mild cognitive impairment (MCI) in primary care has been recognized internationally as one of the strategies that can be employed to delay the development of dementia. However, little is known about what role primary care should play. This study aimed to develop a checklist of conditions necessary for successfully detecting and managing mild cognitive impairment in primary care in China. Methods This study employed the Delphi method to establish expert consensus on the conditions required for successfully detecting and managing MCI in primary care in China. Twenty-four experts who specialized in general practice, public health, neuropsychology, or community health service management rated the importance of pre-defined conditions (44 items measuring providers' preparedness, patient engagement, and system support in line with the Chronic Care Model). The degree of consensus among the experts was measured using four indicators: median ≥ 4, mean ≥3.5, Co-efficient of Variance < 0.25, and retention in the checklist required ≥ 80% agreement with a rating of important or essential. The checklist and descriptions of the conditions were revised according to the experts' feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. Consensus was achieved after the second round of consultations, which was completed by 22 of the experts. Results The experts endorsed a checklist of 47 conditions required for successful detection and management of MCI in primary care in China. These conditions were categorized into four domains: prepared general practitioners (17 items), engaged patients (15 items), organizational efforts (11 items), and environmental support (4 items). Conclusions Successful detection and management of MCI in primary care in China requires a dedicated and competent workforce of general practitioners, as well as the engagement of patients and family caregivers. Adequate support from healthcare organizations, health system arrangements, and the broader society is needed to enable effective interactions between general practitioners and patients and efficient delivery of the services required to detect and manage MCI.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Academic Department of General Practice, Tongji University School of Medicine, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
- Academic Department of General Practice, Tongji University School of Medicine, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Yvonne Wells
- Lincoln Center for Research on Aging, La Trobe University, Melbourne, VIC, Australia
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Karimirad MR, Seyedfatemi N, Mirsepassi Z, Noughani F, Cheraghi MA. Barriers to Self-Care Planning for Family Caregivers of Patients with Severe Mental Illness. J Patient Exp 2022; 9:23743735221092630. [PMID: 35434285 PMCID: PMC9006375 DOI: 10.1177/23743735221092630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The chronic nature of severe mental illnesses is necessary for constant care provided by the family caregivers. Considering the significance of family caregivers in providing care, it is imperative to ensure their self-care if they are to play the role of caregiving effectively and efficiently well. The present study was conducted using the purposive sampling method and in-depth semi-structured interviews among 13 family caregivers and five health team members. The data were analyzed via a conventional content analysis approach. In the data analysis, seven main categories and 18 subcategories emerged: “A troublesome patient and me,” including “Care-induced distress,” “Caring dilemma,” “Emotional fluctuations,” and “Self-forgetfulness”; “Passive–destructive individuality,” including: “Mental stereotypes” and “Unhealthy lifestyle”; “Family turbulence,” including: “Family malfunction” and “Break in family ties”; “The conjoined influencing social factor,” including “Lack of awareness at the family and community level” and “Social stigmatization”; “lack of well-organized health care system,” including “Biomedical-oriented health system,” “Disruption in continuity of care,” and “Problems associated with the support provided by the health system”; “Disturbed economic conditions,” including “Difficulty in life with disrupted financial capability,” “Problems related to education and promoting awareness,” and “Family health care problems”; “Dysfunctional Public mental health,” including “Macro-dysfunction of mental health education,” and “Disruptive advocacy activities to support families of patients with mental disorders.” There are several barriers to family caregiver self-care planning that require health professionals to develop appropriate interventions.
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Affiliation(s)
- Mohammad Reza Karimirad
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Naiemeh Seyedfatemi
- Nursing Care Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Mirsepassi
- Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Noughani
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Cheraghi
- Department of Critical Care and Nursing and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Health Sciences Phenomenology Association, Ministry of Health and Medical Education, Tehran, Iran
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Akenine U, Thunborg C, Kivipelto M, Fallahpour M. Experiences of Participation in a Multimodal Preventive Trial MIND-AD MINI Among Persons with Prodromal Alzheimer's Disease: A Qualitative Study. J Multidiscip Healthc 2022; 15:219-234. [PMID: 35125872 PMCID: PMC8811792 DOI: 10.2147/jmdh.s345607] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Alzheimer's disease (AD) is one of the world's leading public health challenges. One-third of AD cases are attributable to modifiable vascular and lifestyle-related risk factors. The Multimodal Preventive Trial for Alzheimer's Disease, MIND-ADMINI a 6-month multinational parallel-group randomized controlled trial (RCT), targeted persons with prodromal AD and built on the positive outcomes from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) trial. The intervention consisted of four main components of (i) physical exercise training program, (ii) nutrition guidance, (iii) cognitive training, and (iv) social stimulation, as well as (iv) monitoring of metabolic/vascular risk factors. AIM The study aimed to explore and describe the experiences of participation in MIND-ADMINI among persons with prodromal AD. METHODS This qualitative study was part of the larger MIND-ADMINI project. Eight participants were interviewed twice, before and after the intervention. The data was analyzed using qualitative content analysis. RESULTS The results are presented as categories of (i) knowledge of AD and prevention, (ii) motives for study participation, (iii) experiences of the received information about the study, (iv) taking the decision to participate, (v) expectations on study participation, (vi) experiences of study participation and (vii) internal and external factors influencing study participation. CONCLUSION The MIND-ADMINI was well-tolerated by the participants. At the beginning of the study, the number of tasks and visits was perceived as burdensome but was later well-tolerated. The participant' knowledge about AD and prevention increased during the trial. Their motives for participating in MIND-ADMINI were described as both altruistic and self-beneficial. Health benefits from the study components, access to specialized medical care were identified as benefits. Managing the intensive flow of information was described a major challenge. The participants' needs for personalized support during the trial stress the importance of applying a person-centered approach providing the preventive trials.
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Affiliation(s)
- Ulrika Akenine
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Charlotta Thunborg
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
- School of Health, Care and Social Welfare, Department of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Miia Kivipelto
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
- School of Health, Care and Social Welfare, Department of Physiotherapy, Mälardalen University, Västerås, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Stockholms Sjukhem, Research & Development Unit, Stockholm, Sweden
| | - Mandana Fallahpour
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
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Rosin ER, Blasco D, Pilozzi AR, Yang LH, Huang X. A Narrative Review of Alzheimer's Disease Stigma. J Alzheimers Dis 2021; 78:515-528. [PMID: 33044185 PMCID: PMC7739963 DOI: 10.3233/jad-200932] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
As the most common form of senile dementia, Alzheimer’s disease (AD) is accompanied by a great deal of uncertainty which can lead to fear and stigma for those identified with this devastating disease. As the AD definition evolves from a syndromal to a biological construct, and early diagnoses becomes more commonplace, more confusion and stigma may result. We conducted a narrative review of the literature on AD stigma to consolidate information on this body of research. From the perspective of several stigma theories, we identified relevant studies to inform our understanding of the way in which implementation of the new framework for a biological based AD diagnosis may have resulted in new and emerging stigma. Herein, we discuss the emergence of new AD stigma as our understanding of the definition of the disease changes. We further propose recommendations for future research to reduce the stigma associated with AD.
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Affiliation(s)
- Eric R Rosin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Drew Blasco
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Alexander R Pilozzi
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Xudong Huang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
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Beatie BE, Mackenzie CS, Funk L, Davidson D, Koven L, Reynolds KA. Caregiver identity in care partners of persons living with mild cognitive impairment. DEMENTIA 2021; 20:2323-2339. [PMID: 33595336 PMCID: PMC8564256 DOI: 10.1177/1471301221994317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research on caregiver identity in the context of memory impairment has focused primarily
on more advanced stages of the cognitive impairment trajectory (e.g., dementia
caregivers), failing to capture the complex dynamics of early caregiver identity
development (e.g., MCI; mild cognitive impairment caregivers). The aim of this study was
to develop a nuanced understanding of how caregiver identity develops in family and
friends of persons living with MCI. Using constructivist grounded theory (ConGT), this
study explored caregiver identity development from 18 in-depth interviews with spouses
(n = 13), children (n = 3), and friends
(n = 2) of persons recently diagnosed with MCI. The overarching themes
influencing MCI caregiver identity development included MCI changes, care-related
experiences, “caregiver” interpretation, and approach/avoidance coping. These themes
influenced how participants primarily identified, represented as I am a caregiver,
I am not a caregiver, or liminality (i.e., between their
previous identity and a caregiver identity). Irrespective of their current
self-identification, all conveyed thinking about their “future self,” as providing more
intensive care. MCI caregiver identity development in family and friends is a fluid and
evolving process. Nearly all participants had taken on care tasks, yet the majority of
these individuals did not clearly identify as caregivers. Irrespective of how participants
identified, they were engaging in care, and would likely benefit from support with
navigating these changes and their new, ambiguous, and evolving roles.
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Affiliation(s)
- Brooke E Beatie
- Department of Psychology, 194379University of Manitoba, Winnipeg, Manitoba, Canada
| | - Corey S Mackenzie
- Department of Psychology, 194379University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura Funk
- Department of Sociology and Criminology, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dylan Davidson
- Department of Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley Koven
- Department of Clinical Health Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristin A Reynolds
- Department of Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
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