Exploring the affective dimension of the life review process: Facilitators’ interactional strategies for fostering personhood and social value among older adults with early dementia

We employed an auto-ethnography approach to explore the affective dimension of life review sessions with community-dwelling older military veterans with minor cognitive impairment (MCI) and early dementia. Using researchers’ analytic memos, we identified facilitators’ interactional strategies that fostered the participant’s sense of personal identity, dignity and social self-worth. Interaction among participant, caregiver, and facilitators evoked a range of emotional responses, offering a window into the affective world of MCI and early dementia. Positive emotional responses outnumbered negative emotional responses by a ratio of two-to-one in the life review sessions; however, negative emotions were more revelatory of current struggles with declines in health and function. Facilitators utilized two interactional strategies, in particular, to foster personhood and social value of participants: focusing on the participant and creating an empathic connection with the participant. Further work is needed to understand the role of emotions in research interactions and to examine the psychosocial mechanisms through which positive affect functions in promoting identity, personhood and social value among persons with MCI and early dementia.

'Like a sieve': an exploratory study on cognitive impairments in patients with multiple myeloma

The aim of this study was to obtain a more in-depth understanding of cognitive impairments and concerns as described by patients with multiple myeloma and the strategies used to cope with them. Semi-structured qualitative interviews were undertaken with 15 multiple myeloma patients of differing age ranges and at various stages of their disease. Various cognitive impairments, such as problems with short-term memory, poor recall and lack of concentration were observed and/or expressed in at least 10 out of 15 patients, all of them long(er)-term survivors. In some patients cognitive impairments significantly interfered with their personal and professional lives, and for some patients these were described as permanent. The patients used various coping strategies, from denial, taking notes, writing diaries, reading simpler texts, using talking books and videos, to using systems for counting medication to cope with the results of their cognitive impairment. Our findings differ from much of the contemporary literature which states that if cognitive impairments in cancer patients occur, they are mostly mild and transient. More proactive supportive care is needed to help patients with multiple myeloma to cope with poorer cognitive functioning.

Process of ambivalent normalisation: experience of family caregivers of elders with mild cognitive impairment in Taiwan

AIMS AND OBJECTIVES

To conceptualise the caregiving process in Taiwanese families caring for elders with mild cognitive impairment.

BACKGROUND

Family caregivers play an essential role in the lives of elders with mild cognitive impairment by dealing with their cognitive status and daily function. Little is known, however, about the development of the caregiving trajectory, particularly in Asian countries.

DESIGN AND METHODS

Grounded theory methodology was used. Data were collected via in-depth interviews with 10 family caregivers of patients with mild cognitive impairment and living at home in northern Taiwan. Data were analysed by constant comparative analysis.

RESULTS

The process most used by family caregivers to adjust to conflicts and changes in relationships with elders with mild cognitive impairment was 'ambivalent normalisation'. This dynamic process included three components: subtle changes, optimistic appraisal and ambivalent anticipation. Family caregivers who had developed this process were more likely to adopt multiple effective behavioural approaches to avoid conflict in their daily life and to begin outlining future caregiving tasks.

CONCLUSIONS

The process of ambivalent normalisation can sensitise healthcare providers to family caregivers' needs and provide a basis for developing frameworks for future substantive theory and possible future research.

RELEVANCE TO CLINICAL PRACTICE

This study's findings may help healthcare providers understand family caregivers' needs and effective patterns for taking care of elders with mild cognitive impairment. Interventions can be developed to facilitate family caregivers' awareness of the changes in their loved one in the initial stage of diagnosis and adopt multiple effective strategies to prevent conflicts in their lives. Healthcare providers can actively examine the cognitive function of older people in general outpatient departments, provide well-timed treatments and minimise caregiver burden.