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July 21, 2014
Dementia “The international journal of social research and practice"
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
Towards living well with young onset dementia: An exploration of coping
from the perspective of those diagnosed
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
Aim: To study the
influence of cultural believes on the
acceptance and accessibility of dementia services by patients from British
Minority Ethnic (BME) groups.
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.
To undertake a systematic inquiry into the experience of living with dementia
in the community.
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.
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
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
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.