August 14, 2015

journal DEMENTIA - July 2015; 14 (4)




Table of Contents
July 2015; 14 (4)
 
*to get the full text of articles or reserved the books reviewed - members of AANSW - please email the Library on nsw.library@alzheimers.org.au
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Articles
 

Gnosall Primary Care Memory Clinic: Eldercare facilitator role description and development

Dementia July 2015 14: 389-408,


The Gnosall Primary Care Memory Clinic has been operating since 2006 and adds the skills of a specialist old age psychiatrist to the extensive skills and knowledge available in primary care. Key to the organisation and function of the clinic is the eldercare facilitator, a new role situated in primary care and linking with the specialist and a wide range of other agencies and people. In order to facilitate replication of the model elsewhere, the function, role and competencies of existing and previous eldercare facilitators in the clinic have been reviewed, clarified and related to a competency framework and to similar initiatives in the literature. The selection and training of people with the attributes and skills required to become an eldercare facilitator will determine whether extension of the model is successful elsewhere.

 

 Generative acts of people with dementia in a long-term care setting

Dementia July 2015 14: 409-417,


Although generativity is used as a central cultural construct within life course theory to illustrate how older persons create interpersonal ties, it is also tied to key concepts in social exchange theory since generative acts can provide a way for achieving more equity in intergenerational power relationships. Without opportunities for older adults to invest themselves in younger generations, they may no longer feel needed within their family or community. In this article, we discuss the relationship of generativity and dementia through the generative activities of older persons with cognitive decline. Field notes from 8 months of research in a dementia-care setting as well as interviews with 20 residents were thematically analyzed to identify: (a) generative acts among people with dementia; (b) residents’ expressions regarding giving to others; and (c) barriers to generativity. Examining generativity among people with dementia requires that one considers the subjective experience of the condition and understands that many social behaviors remain intact irrespective of any quantified cognitive loss (captured here through the use of case examples).

 

Qualitative evaluation of a self-management intervention for people in the early stage of dementia

Dementia July 2015 14: 418-435,


Self-management programs are effective for people living with chronic illnesses. However, there has been little research addressing self-management for people with dementia in the early stages. This study presents a qualitative evaluation of the experiences of attending a novel self-management program and initial process evaluation. The program was designed with and for people with dementia. It addresses: (a) relationship with family, (b) maintenance of an active lifestyle, (c) psychological well-being, (d) techniques to cope with memory changes and (e) information about dementia. Six participants with early stage dementia completed the intervention that was co-delivered by lay and clinical professional tutors. Participants and tutors attended focus group and interviews at the end of the program to explore their perceptions of the intervention. These were audio-recorded, transcribed verbatim and analysed thematically. Participants reported enjoyment and benefits from the intervention. This was despite some reporting concerns relating to their memory difficulties. The program's flexible nature, focus on strengths and the opportunity to spend time with other people living with dementia were particularly well received. Participants and tutors outlined areas for further improvement. The program was feasible and its flexible delivery appeared to facilitate participant benefit. Emphasis should be placed on maintaining activity and relationships, improving positive well-being and social interaction during the program. Memory of the pleasant experience and strengths focus was evidenced, which may impact positively on quality of life. The results highlight the usefulness and acceptability of self-management for people with early stage dementia and provide initial support for the program's structure and content.

 

The role of a clinical nurse consultant dementia specialist: A qualitative evaluation

Dementia July 2015 14: 436-449,


o Delay in diagnosis and difficulties in accessing appropriate health care services plague dementia care delivery in the community setting, potentiating the risk for misdiagnosis, inappropriate management, poor psychological adjustment and reduced coping capacity and ability to forward plan. We evaluated a clinical nurse consultant role with a speciality in dementia to provide person-centred pre-diagnosis support in the community. Clients, with a six-month history of cognitive and functional decline in the absence of delirium but no formal diagnosis of dementia, were recruited from a Home Care Nursing Service and an Aged Care Assessment Service located in the Western Suburbs of Melbourne, Victoria, Australia. The role of a clinical nurse consultant was highly regarded by clients and other health professionals. This paper discussing the CNC role and the outcomes of the role suggests it was successful in providing timely assistance and support for consumers and support for other health professionals. Gillian Stockwell-Smith,

o Wendy Moyle,

o Ursula Kellett,

o and Henry Brodaty

 

Community practitioner involvement in collaborative research

Dementia July 2015 14: 450-467,


*           This paper focuses on the benefits and limitations of collaborative research in community-based service settings explored through the implementation of a psychosocial intervention. The study aimed to establish the effectiveness of working with dementia dyads (person with dementia and family caregiver) in the early stages of dementia and to recruit and train an existing practitioner workforce to deliver a psychosocial intervention designed to assist dementia dyads to manage the consequences of dementia. Seven intervention staff participated in post-intervention semi-structured interviews. Whilst staff recruitment and retention proved challenging the degree to which staff demonstrated the required communication skills and competence was an important component in dyad acceptability of the intervention. Participatory factors, collaborative development, selective recruitment, focused training and ongoing specialist support, can assist the implementation of practice-based research. However, intervention staff participation and therefore intervention delivery can be hampered by workplace culture and workforce demands.

The development and evaluation of an educational intervention for primary care promoting person-centred responses to dementia

Dementia July 2015 14: 468-482,


*           Background Early diagnosis of dementia within primary care is important to allow access to support. However, dementia remains under-detected in general practice.

*           Aim This work aimed to develop and evaluate an educational intervention for primary care promoting person-centred responses to people experiencing cognitive decline.

*           Conclusions A dementia education intervention for primary care which fosters person-centred attitudes can involve all members of a primary care team. Further research is needed to ascertain if improvements in knowledge and attitudes translate into improved practice.

*            

Differences in diagnosis, follow-up and treatment of patients with dementia living in the peripheral areas compared with the central areas of Israel

Dementia July 2015 14: 483-493


We compared data regarding diagnosis, treatment and follow-up of patients with dementia in the central and the peripheral areas of Israel. Data were collected from the medical records of 164 patients with advanced dementia, all residents of dementia special care units – 97 patients from a central nursing home and 67 patients from the peripheral areas. The data collected related to the period prior to hospitalization and included: demographic data, imaging tests, follow-up by a memory clinic and drug treatment prior to admission. Mini Mental State Examination on admission was also recorded. Patients in the peripheral areas were hospitalized while having better cognitive function, as demonstrated by the Mini Mental State Examination (p < 0.05). More patients in the central areas versus the peripheral areas were aided by an in-house worker prior to admission (p < 0.001). More patients with dementia in the central areas were followed up by a memory clinic (p < 0.001) and underwent brain imaging (p < 0.01) compared with patients with dementia living in the peripheral areas. Although not significant, patients from the central areas were more commonly treated with atypical neuroleptics for behavioral problems (p = 0.05). On the basis of the current data, we suggest that there are differences in the diagnosis, follow-up and drug treatment among patients with dementia living in the central areas versus those living in the peripheral ones. Patients in the peripheral areas are hospitalized while their cognitive abilities are relatively better than those of the patients in central areas.

 

Family caregivers’ perspectives on dementia-related dressing difficulties at home: The preservation of self model

Dementia July 2015 14: 494-512,


Alzheimer’s caregiving literature acknowledges dressing as a major daily stressor but research on this topic is negligible. A qualitative grounded theory approach was used to explore Alzheimer’s family caregivers’ perspectives about issues that arise when their family members lose the ability to dress independently. Three focus groups and seven individual interviews were conducted and audio recorded with 25 information rich caregivers. Constant comparative analyses and coding of the transcripts identified six major themes leading to a ‘Preservation of Self Model: Care Recipient to Care Giver’ that portrays the caregiving trajectory. Initially, caregivers tried to protect the self dignity of the family member by maintaining usual routines and absorbing blame for difficulties. Dressing ‘battles’ occurred and caregivers learned management through trial and error. Crossing adult–child-gender role boundaries escalated discomfort. When facing unrelenting demands, concern shifted to preservation of the caregivers’ health and self. Results suggest that caregivers would benefit from more pro-active dressing counseling to shorten the trial and error periods, dressing aids more relevant to dementia and more knowledgeable helpers. The preservation model can facilitate understanding of the caregiving trajectory and guide intervention support.

 

Dementia service centres in Austria: A comprehensive support and early detection model for persons with dementia and their caregivers – theoretical foundations and model description

Dementia July 2015 14: 513-527,

 

Despite the highly developed social services in Austria, the County of Upper Austria, one of the nine counties of Austria had only very limited specialized services for persons with dementia and their caregivers in 2001. Support groups existed in which the desire for more specialized services was voiced. In response to this situation, funding was received to develop a new structure for early disease detection and long term support for both the person with dementia and their caregivers. This article describes the development of the model of the Dementia Service Centres (DSCs) and the successes and difficulties encountered in the process of implementing the model in six different rural regions of Upper Austria. The DSC was described in the First Austrian Dementia Report as one of the potential service models for the future.

 

SAGE Choice article

Aggressive behaviors between residents with dementia in an assisted living residence

Dementia July 2015 14: 528-546,


Aggressive behavior between residents with dementia in long-term care residences is a concerning but understudied phenomenon. The goal of the study was to identify the circumstances, sequence of events, and triggers that lead to these behaviors. I collected the data during 10 months in two special care units of an assisted living residence. I used participant observation as the primary data collection strategy, complemented by review of clinical records and semi-structured interviews with care staff and managers. As the analytic framework, I used Grounded Theory informed by Miles and Huberman’s approach. In a substantial number of the reported 85 incidents, I identified observable early warning signs; in the majority, I identified observable causes or triggers prior to the aggressive acts. The majority of incidents were situational-reactive (circumstance-driven) and therefore potentially modifiable. Twelve effective staff prevention strategies were identified. I suggest incorporating the study findings into care staff training programs.

 

Book Reviews

*        Book review: Editorial

Dementia July 2015 14: 547

This edition features two reviews: Memory and Communication Aids for People with

Dementia by Michelle Bourgeois offers a range of approaches to facilitate the engagement

of people living with dementia within social activities; whilst Beyond Loss: Dementia,

Identity, Personhood by Lars-Christer Hyde´n, Hilde Lindemann and Jens Brockmeier

(eds) embeds the concept of loss within transitions of personality and identity throughout

the dementia journey.

 

 


Michelle S Bourgeois, Memory and communication aids for people with dementia

Dementia July 2015 14: 548-549,

The approach taken by Michelle Bourgeois in this new publication is an inherently practical

one, aimed at clinicians, care providers and family carers to assist effective communication

with people they support, who live with dementia. The book starts by examining the role of

memory aids and books as a compensatory system to remedy memory deficits, as an

alternative to repetitive ‘drilling’, or developing strategies for remembering information in

people experiencing changes in their memory. The author discusses the importance of

reading in the process of using memory aids, as well as how the physical characteristics of

the aid itself may affect its impact. Furthermore, she points out the importance of staff buy in

and training when ensuring that memory aids are used as effectively as possible in the care setting.

 

Lars-Christer Hydén, Hilde Lindemann and Jens Brockmeier (eds), Beyond loss: dementia, identity, personhood

Dementia July 2015 14: 549-551,

 

The notion of loss is central to popular as well as medical conceptions of dementia. Different

cognitive and linguistic losses involved in the progression of the illness are the focus of much

attention. As its title suggests, the edited book Beyond Loss: Dementia, Identity, Personhood

seeks to move beyond this well-established focus on loss. Instead, it puts forth an

understanding of dementia in terms of transformation of personhood and identity that is

shared with others and takes place within a larger social context. Gathering contributions

from a range of disciplinary and interdisciplinary perspectives, such as the caring and

health sciences, nursing, psychology, philosophy, medical anthropology, gerontology,

neuropsychology, linguistics and communication studies, this book explores how persons

with conditions of dementia (particularly Alzheimer’s disease), remain active agents in

communicating with others, navigating and making sense of the world and of their own

changing condition.

Beyond Loss seeks to challenge both a deep-rooted focus on the person as an isolated

individual and the widespread notion that loss of cognitive and linguistic abilities across the

trajectory also implies a progressive loss of selfhood and identity. It takes issue with the

traditional view that considers individual cognitive abilities and memory the essence of

a person’s identity, locating cognitive abilities and personhood exclusively in the brain.

In contrast to such a view, each chapter stresses the relational character of personhood

and draws attention to different ways in which persons are situated in relation to others

and the surrounding social, cultural and physical world. They further point to the formative

aspects of these relations and discuss personhood and identity in terms of continuous processes of transformation and change.


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