July 21, 2014

Dementia “The international journal of social research and practice"

July 2014; 13 (4)
Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing NSW.Library@alzheimers.org.au 
Wayfinding difficulties among elders with dementia in an assisted living residence
1.     Eilon Caspi
The concerning phenomena of spatial disorientation and wayfinding difficulties among elders with Alzheimer’s disease or a related dementia in assisted living residences are understudied. This qualitative study aimed to identify the types of wayfinding difficulties as experienced by residents with memory-loss in two special care units of an assisted living residence. A wide spectrum of wayfinding difficulties was identified as experienced by residents. The residents experienced difficulties reaching several destinations on the units. The implications of the findings to practice, architectural design, and policy are discussed.
Towards living well with young onset dementia: An exploration of coping from the perspective of those diagnosed
1.    Gemma Clemerson 2.    Sue Walsh 3.    Claire Isaac
There is increasing recognition that dementia in people under 65 years represents a unique challenge to sufferers and services alike. However, by either ignoring this population or sampling them together with older adults, current research has failed to reflect this. This study explored the specific experience of living and coping with Alzheimer’s disease in younger life from the perspective of those diagnosed. Semi-structured interviews were analysed using interpretive phenomenological analysis, and four themes were identified: ‘disruption of the life-cycle’, ‘identity’, ‘social orientation’ and ‘agency’. The experience of living and coping with young onset Alzheimer’s disease was strongly situated within an individual’s social context. Most significantly, participants felt too young to develop the disease and felt out of time with age-related psychological tasks. Coping strategies that attempted to redress and normalise the life-cycle were identified. The contributions of the study are discussed in the context of the human development literature.
Complexity in cognitive assessment of elderly British minority ethnic groups: Cultural perspective
1.    Farooq Khan 2.    George Tadros
Aim: To study the influence of cultural believes on the acceptance and accessibility of dementia services by patients from British Minority Ethnic (BME) groups.
Results: It is noted that non-White ethnic populations rely more on cultural and religious concepts as coping mechanisms to overcome carer stress. In British Punjabi families, ageing was seen as an accepted reason for withdrawal and isolation, and cognitive impairment was rarely identified. Illiteracy added another complexity, only 35% of older Asians in a UK city could speak English, 21% could read and write English, while 73% could read and write in their first language. False positive results using Mini Mental State Examination was found to be 6% of non-impaired white people and 42% of non-impaired black people. Cognitive assessment tests under-estimate the abilities in BME groups. Wide range of variations among white and non-White population were found, contributors are education, language, literacy and culture-specific references.
Dementia: The need for attitudinal change
1.    Grace O’Sullivan 2.    Clare Hocking 3.    Deb Spence
Objective To undertake a systematic inquiry into the experience of living with dementia in the community.
Design Action research, underpinned by critical hermeneutics, brought together action and reflection, theory and practice to generate knowledge. Data were gathered by interviews and observations in participants’ homes, and focus group discussions in community settings.
Participants Eleven people with mild to moderate dementia and their primary caregiver aged 59–84, living in Auckland, New Zealand.
Results The findings reveal a conflict between living positively with dementia, and enduring the negative attitudes that typify the dominant social discourse. The central argument arising from the findings is the significance of personal attitudes.
Conclusions Implications for policy makers, health care providers, and caregivers highlight the need to change the ways in which dementia is perceived. The pursuit of positive attitudes will do much to change social perceptions and enable people with dementia to live with a sense of well-being.
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.
Finding meaning in everyday life with dementia: A case study
This paper presents a case study exploring an older woman’s perspective on the quality of her life with dementia. The case study establishes the importance of coherence across the life course in understanding how she evaluates her changed situation in the present compared to the past. The metaphoric description of moving from ‘up there’ to ‘down here’ represents the perceived struggle to maintain a sense of worth despite a marginalised social position. Being able to define self and social identity in ways that preserve a sense of social status is important to find meaning in everyday life. Finding meaning involves looking backwards to sustain continuity with the past and looking forwards to maintain momentum and keep going. A narrative framework is valuable in showing that quality of life is a dimension of meaning associated with maintaining a sense of social worth.
Attachment and coping of dementia care staff: The role of staff attachment style, geriatric nursing self-efficacy, and approaches to dementia in burnout
1.    Taru-Maija Kokkonen 1.    Ylä-Savon SOTE kuntayhtymä, Finland 1.    Richard I.L. Cheston
1.    Rudi Dallos 2.    Cordet A. Smart
Past research suggests that dementia care staff are vulnerable to the development of burnout, which has implications for staff well-being and hence the quality of care for people with dementia. Studying personal vulnerability factors in burnout is important as it can guide staff training and support. Attachment theory suggests that adult attachment styles affect caregiving relationships and individuals’ responses to stress, providing a framework for understanding caregivers’ styles of coping. This cross-sectional survey study examined relationships between staff attachment styles, geriatric nursing self-efficacy, and approaches to dementia in burnout. Seventy-seven members of dementia care staff working on inpatient wards for older people completed self-report questionnaires. Insecure attachment, lower levels of self-efficacy, and more optimistic attitudes in staff were related to higher levels of burnout. Staff training on the role of attachment in dementia care is recommended. Further research is required to explore mediating factors between adult attachment styles and burnout.

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