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Tang X, Wang J, Wu B, Navarra AM, Cui X, Sharp E, Maiya S, Aytur S, Wang J. Navigating Both Roles: A Photovoice Exploration of the Young Adult Balancing Daughterhood and Caregiving for a Mother With Young-Onset Dementia. QUALITATIVE HEALTH RESEARCH 2024:10497323241244986. [PMID: 38885496 DOI: 10.1177/10497323241244986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Young adults thrust into the role of caregiving for parents with young-onset dementia (YOD) face unique challenges during their formative years. While existing research acknowledges the crucial role of young adult caregivers, a gap persists in understanding how this group experiences and redefines their identity amidst these circumstances, along with the psychological and societal challenges encountered. This knowledge deficit hinders the identification of suitable social support, adversely affecting the personal growth and well-being of these young adult caregivers. In this single-case study, we used a combination of a semi-structured interview and photovoice to explore the journey of a 19-year-old caregiver, Alice, whose mother had been diagnosed with dementia in the preceding 3 years. Through this unique perspective, we aimed to illuminate how caregiving for a mother with YOD may profoundly redefine familial roles and relationships. Over 3 months, Alice captured significant life moments through photography, selecting meaningful images for bi-weekly meetings. These images served as pivotal themes, triggering in-depth conversations during subsequent interviews to provide nuanced insights into her life experiences. Findings reveal four major themes faced by a young caregiver: (1) challenges adapting to an unexpected role, (2) navigating the complex emotional terrain of losing a loved one to YOD, (3) prioritizing the well-being of the healthy parent, and (4) expressing a profound desire for both informal and formal support. These results underscore the intricate identity and emotional challenges faced by young adult caregivers, emphasizing the urgency of addressing their unique needs through family-centered systemic support services.
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Affiliation(s)
- Xueting Tang
- School of Nursing, Fudan University, Shanghai, China
| | - Junqiao Wang
- School of Nursing, Fudan University, Shanghai, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Xiaoyan Cui
- School of Nursing, Fudan University, Shanghai, China
| | - Erin Sharp
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Sahitya Maiya
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Semra Aytur
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Jing Wang
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
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2
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Martin SC, Scott AM, Stone AM. Women's Metaphors About BRCA Gene Testing and How They Can Inform Health Communication Theory and Practice. HEALTH COMMUNICATION 2024; 39:603-615. [PMID: 36775863 DOI: 10.1080/10410236.2023.2178051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Genetic testing can detect whether an individual carries a harmful variant in the BRCA1 or BRCA2 (Breast Cancer 1 or 2) gene which, if present, drastically increases a woman's risk for breast and ovarian cancer. The experience of BRCA gene testing can be an emotionally laden process yielding significant uncertainty. In this study, we examined women's experiences of BRCA gene testing by exploring how participants communicatively framed and made sense of this process through the use of metaphors. Comparing uncertain and unfamiliar experiences to familiar references through metaphor can help people in challenging health-related situations with sense-making and communicating complex emotions. Furthermore, metaphors can be employed as a therapeutic tool by health care professionals, but their use has not often been studied regarding experiences of genetic testing, including BRCA gene testing. We conducted in-depth interviews with 42 women who have undergone BRCA gene testing (regardless of results), and analyzed data using constant comparative techniques. Eight categories of metaphors that women used surrounding BRCA gene testing were evident in the data, including those related to (a) knowledge is power; (b) gambling; (c) a journey; (d) a rollercoaster; (e) battle, disaster, or wreckage; (f) Pandora's box or a can of worms; (g) doom and gloom; and (h) the release or placing of a weight. Results enhance our understanding of women's experiences related to the uncertainty-inducing process of BRCA gene testing and lead to valuable theoretical implications and practical recommendations, including regarding the potential use of metaphors in patient-provider communication about BRCA genetic risk.
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Affiliation(s)
- Summer C Martin
- Department of Human Communication Studies, California State University, Fullerton
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3
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Wiggins M, McEwen A, Sexton A. Young-onset dementia: A systematic review of the psychological and social impact on relatives. PATIENT EDUCATION AND COUNSELING 2023; 107:107585. [PMID: 36516659 DOI: 10.1016/j.pec.2022.107585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Young-onset dementia (YOD) has significant impact for the affected person, but also has far-reaching effects on the family. Additionally, biological relatives have an increased genetic risk of developing the condition themselves. This review aimed to identify the psychological and social impacts of YOD in the family, for asymptomatic relatives. METHODS A systematic review of key databases for empirical studies about the lived experience of biological relatives at risk for YOD was performed. Data was collated and interpreted via narrative synthesis. RESULTS The majority of the nineteen included studies were qualitative and explored the experiences of children with a parent with YOD. Five themes were developed: (1) Onset of YOD disrupts family functioning (2) Emotional impact is significant and varied (3) Uncertain future (due to uncertainty of diagnosis, care-giving responsibilities, and their own increased genetic risk) (4) Lack of visibility in health care and society (5) Coping strategies include physical/cognitive distancing, and emotion-focused coping. CONCLUSION Our findings demonstrate a diagnosis of YOD significantly impacts the lives of relatives, yet their experiences and needs often go unnoticed. PRACTICE IMPLICATIONS We present a practical framework of questions and strategies for care of relatives, mapped to the self-regulation model of genetic counselling.
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Affiliation(s)
- Maddison Wiggins
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Adrienne Sexton
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia; Genomic Medicine Department, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Medicine Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
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4
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Bruinsma J, Peetoom K, Verhey F, Bakker C, de Vugt M. Behind closed doors. A case study exploring the lived experiences of a family of a person with the behavioral variant of frontotemporal dementia. DEMENTIA 2022; 21:2569-2583. [PMID: 36164995 PMCID: PMC9583276 DOI: 10.1177/14713012221126312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The behavioral variant of frontotemporal dementia is characterized by
profound changes in personality and behavior that often start before the age
of 65 years. These symptoms impact family life, particularly if (adult)
children live at home. In research on young-onset dementia or frontotemporal
dementia, the family itself is hardly ever a unit of analysis. Insight in
the perspectives of different family members from the same household helps
to obtain a deeper understanding of the complex impact of the symptoms on
family dynamics. Methods This case study explored the perspectives of one family having a relative
with the behavioral variant of frontotemporal dementia living at home. Over
the course of 4 months, different family members were individually
interviewed twice. Two authors independently performed a directed content
analysis. Results The family consisted of a father, mother, and three adult children. Around
3 years before the interviews the father was diagnosed with frontotemporal
dementia. The main category identified was the change in family dynamics over the
disease trajectory. Three subcategories characterized the changing family
dynamics, namely (a) the change in existing roles, relationships and
interaction patterns in the family due to early symptoms, (b) a redefinition
of roles and responsibility in the family once the diagnosis was
established, and (c) the formation of new roles, relationships and
interaction patterns in the family by organizing post-diagnostic support at
home. Conclusion Symptoms of the behavioral variant of frontotemporal dementia have a complex
and profound impact on family dynamics and change existing roles,
relationships, and interaction patterns. Psychosocial support may help
families by accounting for individual differences in involvement, coping,
and bereavement. This may help to create a sense of mutual understanding
between family members that could potentially strengthen their relationship.
This may help families to deal with the difficult challenge of organizing
care for a relative with frontotemporal dementia who lives at home.
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Affiliation(s)
- Jeroen Bruinsma
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, 5211Maastricht University, The Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, 5211Maastricht University, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, 5211Maastricht University, The Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Centre, The Netherlands; Radboudumc Alzheimer Centre, The Netherlands; Groenhuysen, Centre for Specialized Geriatric Care, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, 5211Maastricht University, The Netherlands
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Poole C, Patterson TG. Experiences and Needs of Children Who Have a Parent with Young Onset Dementia: A Meta-ethnographic Review. Clin Gerontol 2022; 45:750-762. [PMID: 32496888 DOI: 10.1080/07317115.2020.1765933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: The aim of the present review was to critically evaluate empirical evidence regarding the needs and experiences of children who have a parent with young onset dementia (YOD).Methods: A systematic search of five databases was carried out and the resulting 16 studies were reviewed using a meta-ethnographic approach.Results: Three main themes arose from the data: 'Dementia Impact", which describes how the child experiences the deterioration in their parent and changes to relationships; "Psychological Impact", comprising the child's private emotional experiences and the psychological consequences of changes in roles; and "Practical Impact", detailing the ways in which children adapt their lives in response to parental YOD, and children's needs for support.Conclusions: These themes synthesize the existing literature and produce a line of argument explaining the experience of children whose parents have YOD.Clinical Implications: Information and policies regarding YOD should take account of the experiences of patients' children and should include targeted support for children of parents with YOD.
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Affiliation(s)
- Courtney Poole
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Tom G Patterson
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Putland E. The (in)accuracies of floating leaves: How people with varying experiences of dementia differently position the same visual metaphor. DEMENTIA 2022; 21:1471-1487. [PMID: 35148618 PMCID: PMC9237850 DOI: 10.1177/14713012211072507] [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] [Indexed: 11/16/2022]
Abstract
Metaphors help shape the social world. Yet, with research and language guidelines focusing primarily on the stigmatising potential of verbal representations, much greater attention is needed regarding visual metaphors' role in perpetuating and challenging particular views of dementia. Through semi-structured interviews and focus groups, this paper explores how people with dementia and their carers and/or loved ones evaluate one prevalent visual metaphor for dementia that maps autumnal trees losing leaves onto the brain/head. Analysis considers three main responses to the metaphor, that: (1) it does not depict dementia; (2) it meaningfully explains a biomedical account of progressive brain deterioration; and (3) it reinforces inaccurate and/or 'hopeless' discourses of what having dementia involves, with individuals suggesting creative alterations to better fit their counter discourses. These findings foreground the importance of attending to subjectivity, nuance and multi-layered discourses within visual metaphors, which can indirectly convey stigmatising representations.
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7
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Hoppe S. Identity work of children with a parent with early-onset dementia in the Netherlands: Giving meaning through narrative construction. DEMENTIA 2022; 21:196-213. [PMID: 34380345 PMCID: PMC8739582 DOI: 10.1177/14713012211033494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the past years an increasing amount of research has been done on the experiences of adult children of a parent with early-onset dementia. However, little is still known about how the socio-cultural context influences the narratives of these children. AIM This study aimed to provide insights into the far-reaching consequences of parental early-onset dementia for adult children in the Netherlands. It illustrates how the experiences of these adult children are shaped by the context they live in. METHOD 16 in-depth interviews were conducted with adult children of a parent with early-onset dementia in the Netherlands. The interviews offered the children space to reflect on the impact the illness of their parent had on them and their lives. The data were analysed using thematic analysis. FINDINGS This article illustrates that the comparative processes of relating to others' experiences help the children to reflect on the impact that their parent's illness has on their own lives, which in turn aids them in contextualising and making meaning out of their changing lives and relationships. This contextualization and recovery of meaning is shaped by three processes. The first concerns the ways these adult children draw comparisons between their own lives and experiences and those of their peers of the same age group. The second process entails comparative understandings of having a parent with early-onset dementia versus having a parent with late-onset dementia. The third process explores how having a parent with early-onset dementia compares to having a parent with other diseases. The processes of contextualisation which the adult children engage in are shaped by what the children perceive to be normal and thus also by their socio-cultural contexts. CONCLUSIONS This article reveals how meaning is created in a constant interplay between the primary experiences of having an ill parent and the socio-cultural context in which the experiences take place. It illustrates how this context provides for particular narratives, which in turn shape how the children are able to give meaning to their experiences.
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Affiliation(s)
- Silke Hoppe
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
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8
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Sexton A, James PA. Metaphors and why these are important in all aspects of genetic counseling. J Genet Couns 2021; 31:34-40. [PMID: 34233383 DOI: 10.1002/jgc4.1463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/07/2021] [Accepted: 06/12/2021] [Indexed: 11/11/2022]
Abstract
Metaphors appear simple but are fundamental schemata allowing expression and processing of complex emotions and information. They are so embedded in language and thinking that we are often unaware of their impact, despite the crucial role of metaphors in communication, learning and creating meaning from experiences. A deeper understanding of how to recognize and work with client-generated and counselor-generated metaphors has great potential as an addition to the genetic counseling 'tool-box'. Here, we draw on studies from related health and psychotherapy fields to discuss how working purposefully with metaphors may offer a powerful way to enhance communication within a reciprocally engaged client-counselor relationship. Metaphors present ways to explain complex genetic concepts in a personally meaningful form, to gain a deeper understanding of client's experiences and emotions, to assist processing of experiences, emotions, and concepts, and to assist client and counselor to access and reflect on subconscious emotions, self-concept, and motivations. In addition, working with metaphors has been shown to facilitate coping and action. This paper sets the scene for why and how genetic counselors can utilize client-generated and counselor-generated metaphors purposefully in all areas of practice, including enhancing the therapeutic interaction with clients, as well as in supervision, training, cultural competence, and shaping of societal attitudes toward genetics.
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Affiliation(s)
- Adrienne Sexton
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Paul A James
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
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Chirico I, Ottoboni G, Valente M, Chattat R. Children and young people's experience of parental dementia: A systematic review. Int J Geriatr Psychiatry 2021; 36:975-992. [PMID: 33826166 PMCID: PMC8252592 DOI: 10.1002/gps.5542] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Most studies have been concerned with the experiences and needs of spouses/partners and adult children of people with dementia. In this review, children and young people's lived experience of parental dementia was investigated. Findings will inform both researchers and professionals in the area of dementia care. DESIGN A systematic literature search was performed in CINAHL, PsychINFO, PubMed, Scopus, and Web of Science. A rigorous screening process was followed, and a checklist for qualitative and observational studies was used to evaluate the methodological quality of the studies. Narrative synthesis of the selected articles was carried out. RESULTS Twenty-one studies were included and a synthesis of the literature revealed six themes. The first theme concerned the difficulties in dealing with the diagnosis which was often preceded by a long period characterized by uncertainty, confusion, family distress, and conflicts. The second theme discussed changes in family relationships in terms of the role of children and young people in supporting both parents and keeping family together. The third theme described the impact of caring on children and young people who struggled to balance caring tasks and developmental needs. The fourth theme showed consequences on children and young people's personal lives in terms of education/career and life planning. The fifth theme illustrated main adaptation models and coping strategies. The last theme discussed the need for appropriate support and services based on a "whole family" approach. CONCLUSIONS The included studies provide the basis for knowledge and awareness about the experience of children and young people with a parent with dementia and the specific needs of support for this population.
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Affiliation(s)
- Ilaria Chirico
- Department of PsychologyUniversity of BolognaBolognaItaly
| | | | - Marco Valente
- Department of PsychologyUniversity of BolognaBolognaItaly
| | - Rabih Chattat
- Department of PsychologyUniversity of BolognaBolognaItaly
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10
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Grundberg Å, Sandberg J, Craftman ÅG. Childrens' and young adults' perspectives of having a parent with dementia diagnosis: A scoping review. DEMENTIA 2021; 20:2933-2956. [PMID: 34096358 DOI: 10.1177/14713012211023653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dementia is a key health issue worldwide. In Sweden, as in other European countries, most persons with dementia live in domestic settings and are often cared for by their family members. This scoping review aims to describe the perspectives of children and young adults with a parent diagnosed with dementia. Young family members may be alone and without support despite their high level of care burden. DESIGN AND METHODS Three electronic databases (PubMed, Web of Science and PsycINFO) were used to search for English-language articles focusing on children and young adults between the ages of 6 and 34 who have a parent diagnosed with dementia. A thematic synthesis of the included articles was performed. FINDINGS Sixteen original published qualitative studies were identified. These studies were categorised based on information about the authors, year of publication, study location, participants, aim of the study, data collection, analysis and main findings. Five main analytical themes were identified: (1) children and young adults identify changes in their parents' behaviour and personality, (2) children and young adults experience changed roles and relationships within the family, (3) children and young adults need to cope with an uncertain future, (4) children and young adults relate changes in their parent to their own mixed emotions and (5) children and young adults need help and seek it out but experience inadequate support. CONCLUSIONS The children and young adults in the included studies seem to provide significant levels of care and support to their affected parent, which may affect their own health, social relations, community participation, employment, education, finances and sense of security. This means that it is important for health care systems and social services to identify barriers to these young family members' access to relevant care and support for themselves.
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Affiliation(s)
- Åke Grundberg
- Department of Learning, Informatics, Management and Ethics, LIME, 27106Karolinska Institutet, Solna, Sweden
| | - Jonas Sandberg
- Department of Caring Science, Sophiahemmet University, Stockholm, Sweden
| | - Åsa G Craftman
- Department of Caring Science, Sophiahemmet University, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, NVS, 27106Karolinska Institutet, Huddinge, Sweden
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11
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Cartwright AV, Stoner CR, Pione RD, Spector A. The experiences of those affected by parental young onset dementia: A qualitative systematic literature review. DEMENTIA 2021; 20:2618-2639. [PMID: 33517771 PMCID: PMC8564265 DOI: 10.1177/1471301220988231] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To develop understanding of the lived experiences of children of people living with young onset dementia, defined as individuals both under and over the age of 18 years whose parent was diagnosed with dementia before the age of 65 years. METHOD A critical appraisal and thematic synthesis of the available qualitative literature regarding the lived experience of individuals whose parent has a diagnosis of young onset dementia. A three-stage approach for conducing thematic synthesis was followed. RESULTS 15 articles were included in the review. Four analytical themes and 11 subthemes were found. The analytical themes were 'making sense of dementia', 'impact of dementia', 'coping' and 'support'. CONCLUSIONS The experiences of those affected by parental young onset dementia vary widely. There is a lack of knowledge and understanding of young onset dementia by professionals and the public, and a scarcity of appropriate support. This has clinical implications for professionals working with families affected by young onset dementia, in particular with regards to service design and delivery.
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Affiliation(s)
- Anna V Cartwright
- Department of Clinical, Educational and Health Psychology, 4919University College London (UCL), UK
| | - Charlotte R Stoner
- Department of Clinical, Educational and Health Psychology, 4919University College London (UCL), UK
| | - Richard D Pione
- Department of Clinical, Educational and Health Psychology, 4919University College London (UCL), UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, 4919University College London (UCL), UK
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12
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Thorsen K, Johannessen A. Metaphors for the Meaning of Caring for a Spouse with Dementia. J Multidiscip Healthc 2021; 14:181-195. [PMID: 33542634 PMCID: PMC7853414 DOI: 10.2147/jmdh.s289104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/12/2021] [Indexed: 12/05/2022] Open
Abstract
Background Spouses of people with young-onset frontotemporal dementia (YO-FTD) (age 65 years or younger) encounter special challenges. The diagnosis is scarcely known; the early onset is unexpected; and the disease is characterized by symptoms varying from those of other types of dementia. Caring implies increasing hardships, which can be difficult to communicate to others when applying for support. Metaphors create and communicate meaning and are increasingly used in health care and health interventions as ways to better understand the situation. Aim To examine the experiences of spouses of people with YO-FTD and their needs for care and support as expressed through metaphors in narratives of their experiences during the development of the dementia. Methods Qualitative interviews with 16 informants (ten women, six men) were conducted in 2014/2015. They were recruited from seven memory clinics, one municipality dementia team, and a nursing home. Steger’s three-step method for analyzing metaphors was applied. Findings The core metaphors cover experiences of the dementia and the transformation of the spouse, changed roles and relationships between spouses, the transformation of the self, a radical turn of existential life, and relationships with others. Metaphors are words and phrases used to talk about complicated, contradictory, shameful, and/or normatively difficult feelings and reactions as caring spouses. The open themes and, at the same time, provide verbal shields and defences. Metaphors are especially effective for expressing the strength of the reactions in caring as emotional work and are tools for mastering emotions and challenges in life. Conclusion Metaphors give insights into the significant experiences of spouses of partners with YO-FTD and offer personnel in health services a better understanding of their needs for tailored support and help.
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Affiliation(s)
- Kirsten Thorsen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway
| | - Aud Johannessen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway
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13
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Thorsen K, Dourado MCN, Johannessen A. Awareness of dementia and coping to preserve quality of life: a five-year longitudinal narrative study. Int J Qual Stud Health Well-being 2020; 15:1798711. [PMID: 32780653 PMCID: PMC7482873 DOI: 10.1080/17482631.2020.1798711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose To examine how people (<65 years) with young-onset dementia (YOD) express awareness of dementia and how they seem to handle awareness as a strategy to preserve quality of life over time. Method A longitudinal qualitative study with individuals with YOD was performed with interviews every 6 months over 5 years for a maximum of 10 interviews. The interviews were analysed by modified grounded theory adapted to narrative inquiry. Results Awareness is a complex, multidimensional concept. Awareness of dementia is predisposed by personality, life history and established coping styles. The main coping styles during dementia—live in the moment, ignore the dementia, and make the best of it—seem to be rather consistent throughout disease progression. Transitions in the life situation may change the individual’s awareness of dementia. Conclusion Unawareness of dementia may have an important adaptive function for preserving quality of life. Increasing awareness of dementia must be approached with reflexivity and great sensitivity.
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Affiliation(s)
- Kirsten Thorsen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tonsberg, Norway.,Norwegian Social Research (NOVA), Oslo Metropolitan University , Oslo, Norway
| | - Marcia C N Dourado
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro , Rio de Janeiro, Brazil
| | - Aud Johannessen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tonsberg, Norway.,Department of Nursing and Health, Faculty of Health and Social Sciences, University of South-Eastern Norway , Norway
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14
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Hartman L, Jenkinson C, Morley D. Young People's Response to Parental Neurological Disorder: A Structured Review. Adolesc Health Med Ther 2020; 11:39-51. [PMID: 32273785 PMCID: PMC7105371 DOI: 10.2147/ahmt.s237807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/08/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction A significant paucity of literature exists relating to the impact on children of parental neurological disorder, with the exception of multiple sclerosis. The wider literature in this field (parental cancer, depression, alcoholism, HIV/AIDS) exhibits the many potential challenges young people might experience during serious parental illness. Given this, a literature review of parental neurological disorder is long overdue. Methods This review is structured around the World Health Organisation (WHO) classification of neurological disorders. The WHO identifies 10 common neurological disorders; dementia, epilepsy, headache, multiple sclerosis, neuroinfections, neurological disorders associated with malnutrition, pain associated with neurological disorders, Parkinson's disease, stroke, and traumatic brain injury. A comprehensive search of the MEDLINE database was performed using key terms for each of the 10 conditions. Results for each condition were divided in to "negative", "positive and/or neutral" and "other" child responses. Results The search yielded a total of 6247 titles, of which 184 underwent a full-text assessment. Sixty-five met all eligibility criteria and were thus included in the review. A number of negative issues emerged across parental conditions including the prevalence of child mood disorders, parent-child role reversal, children's need for information on the parental condition, the importance of family cohesion, the negative effect of parental psychopathology and differences between male and female children. A limited number of positive outcomes were evident in a minority of parental conditions. Outcomes measured and methodologies employed were highly heterogeneous. Conclusion Children generally respond negatively to parental neurological disorder. Responses varied between neurological disorders, suggesting the need for parental disease-specific guidance and clinical management where required.
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Affiliation(s)
- Lilian Hartman
- Lincoln College, University of Oxford, Oxford OX1 3DR, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - David Morley
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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Lövenmark A. How Children of Parents With Dementia Can Make Their Subject Positions Understandable and Meaningful. QUALITATIVE HEALTH RESEARCH 2020; 30:704-716. [PMID: 31530223 PMCID: PMC7322943 DOI: 10.1177/1049732319873051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The families of people diagnosed with dementia are commonly first-in-line caregivers. This can have a considerable effect on their lives, health, and relationships. However, few studies have focused on the children in such families. Therefore, the aim of this study was to describe how children, in their own narratives, construct themselves as subjects growing up and caring for a parent with dementia. The study applies discourse analysis. The findings show three subject positions: parent to your parent(s), orphan with parents, and time traveler stuck in time. There is a need to support these children, both as children and as young adults. More knowledge is necessary regarding the kind of support they might want or need. For health care professionals, it is important to know that it might not always be easy to ask for information or support as a child caring for a sick parent.
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Affiliation(s)
- Annica Lövenmark
- Mälardalen University, Västerås, Sweden
- Annica Lövenmark, School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås 72123, Sweden.
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Sikes P, Hall M. "It was then that I thought 'whaat? This is not my Dad": The implications of the 'still the same person' narrative for children and young people who have a parent with dementia. DEMENTIA 2018; 17:180-198. [PMID: 26951362 PMCID: PMC5802543 DOI: 10.1177/1471301216637204] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This research used auto/biographical interviews to explore the experiences of 19, 8 to 31 year olds who had a parent with dementia. Thematic analysis revealed challenges occasioned by the master narrative that people with dementia are 'still' the same person they were prior to the onset of their condition. While this notion is - rightly - at the heart of person-centered care in dementia services, the 'still' discourse conflicts with the experiences of young people. Their accounts suggest that the construction of their parent as the same person is not helpful and that, furthermore, expectations that they will behave and feel towards that parent as they did before are a source of distress in what is already a challenging situation. This paper highlights the need to equip young people with support that acknowledges that their parent may well be drastically different to the Mum or Dad they previously 'knew'.
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Affiliation(s)
- Pat Sikes
- School of Education, University of Sheffield, UK
| | - Mel Hall
- School of Education, University of Sheffield, UK
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Hall M, Sikes P. "It Would Be Easier If She'd Died": Young People With Parents With Dementia Articulating Inadmissible Stories. QUALITATIVE HEALTH RESEARCH 2017; 27:1203-1214. [PMID: 28682738 PMCID: PMC5467781 DOI: 10.1177/1049732317697079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In the U.K. context where the emphasis is (quite rightly) on living well with dementia, on positivity and enabling approaches, it can be difficult for researchers to investigate and report negative experiences. Failing to re-present perceptions and experiences as they are lived, however, does a serious disservice to the research endeavor and can prevent policy and service development and positive change. In this article, we present some stories told by participants in an Alzheimer's Society (United Kingdom) Funded project uniquely investigating the perceptions and experiences of children and young people who have a parent with dementia. Sometimes the stories were not easy to hear, especially when they challenged dominant master narratives around dementia. We discuss our view that when the young people we spoke with told us how things were for them, we were ethically bound to respect and disseminate their accounts.
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Affiliation(s)
- Mel Hall
- University of Sheffield, Sheffield, United Kingdom
- Mel Hall, School of Education, University of Sheffield, 388 Glossop Road, Sheffield S10 2JA, UK.
| | - Pat Sikes
- University of Sheffield, Sheffield, United Kingdom
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18
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Gelman CR, Rhames K. In their own words: The experience and needs of children in younger-onset Alzheimer's disease and other dementias families. DEMENTIA 2016; 17:337-358. [DOI: 10.1177/1471301216647097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Kate Rhames
- Preventable Admissions Care Team (PACT), Mount Sinai Hospital, NY, USA
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Hall M, Sikes P. From "What the Hell Is Going on?" to the "Mushy Middle Ground" to "Getting Used to a New Normal": Young People's Biographical Narratives Around Navigating Parental Dementia. ACTA ACUST UNITED AC 2016; 26:124-144. [PMID: 29628752 PMCID: PMC5865472 DOI: 10.1177/1054137316651384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The number of young people who have a parent with dementia is rising as a result of improvements in diagnosis of young onset variants and demographic shifts. There has, however, been very little research focusing on this group. Accounts elicited as part of the Perceptions and Experiences of Young People With a Parent With Dementia described the period, usually some years, leading up to a diagnosis of a dementia and then the progress of the condition post diagnosis. These narratives were characterized by confusion, uncertainty, trauma, and distress as the young people struggled to make sense of the significant and often extreme, behavioral and attitudinal changes that were symptoms of the illness. This article describes and discusses how the young people experienced and navigated the temporal messiness and consequent biographical disruption arising from parental dementia.
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Affiliation(s)
- Mel Hall
- University of Sheffield, Sheffield, UK
| | - Pat Sikes
- University of Sheffield, Sheffield, UK
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20
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Johannessen A, Engedal K, Thorsen K. Coping efforts and resilience among adult children who grew up with a parent with young-onset dementia: a qualitative follow-up study. Int J Qual Stud Health Well-being 2016; 11:30535. [PMID: 27065463 PMCID: PMC4827146 DOI: 10.3402/qhw.v11.30535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 11/14/2022] Open
Abstract
Background It is estimated that one in four persons with young-onset dementia (YOD) (<65 years old) has children younger than 18 years old at the onset of the dementia. These children experience a childhood different from what is expected. Adult children of parents with YOD are seldom addressed in research, and the impact of the dementia on the children's development over time has rarely been studied. Aim The goal of this study was to explore how adult children experienced the influence of their parents’ dementia on their own development during adolescence; what coping efforts, strategies, and resources they employed; and how they evaluated the most recent changes in their life situation. Method A follow-up, grounded theory approach in two phases was used. Qualitative interviews with 14 informants (18–30 years of age) were conducted in 2014 and one year later, in 2015. Findings Nearly all the informants expressed that their emotional well-being and their life situation were better at the second interview compared to the time of dementia onset in their parents. To overcome the difficulties of being a child of a parent with YOD, they used different instrumental, cognitive, and emotional coping strategies, subsumed analytically under the concept detachment. This category covers three subcategories of coping strategies: moving apart, greater personal distance, and calmer emotional reactions. Another category, resilience, designates combinations of the coping strategies. Vital for the development of coping resources and resilience was the need the informants had for social support—for people they saw who listened to them and responded to their needs. Conclusion Most of the informants reported that they experienced a better life situation and less emotional stress over time as their parent's dementia progressed. They developed better coping capacities and greater resilience. Vital for the development of coping resources and resilience was the need the informants had for social support.
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Affiliation(s)
- Aud Johannessen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway;
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Kirsten Thorsen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Norwegian Social Research NOVA, University College of Oslo and Akershus, Oslo, Norway
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