October 06, 2017

Dementia – The international journal of social research and practice

Volume 16, Issue 6, August 2017

Full text articles and books are available to members of Alzheimer’s Australia NSW by emailing NSW.Library@alzheimers.org.au

Dementia and the privilege of growing old
“….. rightly argue that ‘dementia discourse must acknowledge the limitations associated with this condition, while discovering the remaining pleasures’ . Accepting dementia – warts, wandering and all – rather than trying to ‘beat’ or ‘overcome’ it, involves challenging the persistent myths of dementia without oversimplifying the lived experience. The same must be done for aging and dying. While a ‘living well’ lens helps counteract the inaccurate past portrayals that perhaps make sense for clinical research, biomedical institutions or even advocacy agencies, it is harmful for the most deeply forgetful among us – and all of us as we envision ourselves as future old people. Such skewed and reductionist representations must be balanced with more accounts that reveal the full spectrum of experiences at each phase of the illness over time, including the late-stage and death, as well as the active citizenship of people with dementia. We must also challenge institutional ageism by interrogating the misrepresentations in medical arenas and the mass media alike to foster the ‘role of society and culture in repositioning dementia away from deficit to a discourse of agency and interdependence’ (Birt, Poland, Csipke, & Charlesworth, 2017, p. 199; emphasis added). If we want to bring some humanity to forgetfulness and aging, then we must (continue to) insist that dementia does not destroy either sociality or personhood. Meaningful social change must start with the readership of this journal. If not us, then who?’’
pp. 685–688

Music therapy: A nonpharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia
 Kendra D Ray ;   Mary S Mittelman;

Depression, agitation, and wandering are common behaviors associated with dementia and frequently observed among nursing home residents. Even with pharmacological treatment, behaviors often persist, hindering quality of life for elders, their family, and paid caregivers.
Participants were evaluated for depressive symptoms, agitation, and wandering to determine their predominate behavior. There were two assessments, two weeks apart, prior to intervention, followed by a two-week intervention, and two follow-up assessments, also two weeks apart.
 A repeated measures ANOVA determined that after two weeks of music therapy, symptoms of depression and agitation were significantly reduced; there was no change for wandering. Multivariate analyses confirmed a relationship between music therapy and change in neuropsychiatric symptoms associated with dementia. Results suggest widespread use of music therapy in long-term care settings may be effective in reducing symptoms of depression and agitation.
pp. 689–710

Digital communication support and Alzheimer’s disease
 Anna Ekström; ,  Ulrika Ferm;  Christina Samuelsson;

Communication is one of the areas where people with dementia and their caregivers experience most challenges. The purpose of this study is to contribute to the understanding of possibilities and pitfalls of using personalized communication applications installed on tablet computers to support communication for people with dementia and their conversational partners. The study is based on video recordings of a woman, 52 years old, with Alzheimer’s disease interacting with her husband in their home. The couple was recorded interacting with and without a tablet computer including a personalized communication application.
The results from the present study reveal both significant possibilities and potential difficulties in introducing a digital communication device to people with dementia and their conversational partners. For the woman in the present study, the amount of interactive actions and the number of communicative actions seem to increase with the use of the communication application. The results also indicate that problems associated with dementia are foregrounded in interaction where the tablet computer is used.
pp. 711–731

From wandering to wayfaring: Reconsidering movement in people with dementia in long-term care
 Megan E Graham;

The movement of people with dementia in long-term care continues to be an issue of concern among clinicians, caregivers and families. This article will examine the social construction “wandering” and its association with pathology, risk discourse and surveillance technologies. Further, the article will explore the recent shift from the term “wanderer” to the phrase “people who like to walk” in person-centred dementia care. Engaging with Ingold’s concept of movement as wayfaring, an alternative becoming-centred understanding of movement and its significance for people with dementia will be presented and illustrated through a case study.
The paper concludes that depathologizing movement opens the possibility to see movement in people with dementia as an intention to be alive and to grow, rather than as a product of disease and deterioration. Suggestions for future research and implications for care interventions are discussed.
pp. 732–749

Social housing provision for minority ethnic older people with dementia: Findings from a qualitative study
 Valerie Lipman; ,  Gillian Manthorpe

Little research has explored how not-for-profit housing providers, often termed Housing Associations in the United Kingdom, meet the needs of older tenants with dementia who are from black and ethnic minority communities. This article presents findings from an exploratory study conducted in 2015. The study took an audit approach, investigating current practice and policy in 12 Housing Associations. All were developing their understanding of dementia; some were augmenting their standard rented property portfolio to include housing with care provision; and most had policies relating to equalities and diversity and were offering dementia training to members of staff. None appeared to have fully integrated the three strands of housing services, dementia care, and cultural or ethnicity-related needs and preferences. A range of strategies was reported as being developed to meet tenants’ changing circumstances. Anxiety about the cost of adaptations was commonly reported, although the nature and extent of this were ill-defined. Discussion focuses on the findings’ implications for housing providers and for dementia professionals.
First Published November 8, 2015; pp. 750–765

Structural equation model linking dementia cognitive functioning, caregiver mental health, burden, and quality of informal care in Argentina
 Alejandra Morlett Paredes;   Paul B Perrin; Silvina V Peralta;  Miriam E Stolfi; Eliana Morelli;  Juan Carlos Arango-Lasprilla

The purpose of this study was to create a path model linking cognitive functioning in individuals with dementia, caregiver burden and mental health, and quality of care provided for the individual with dementia in Argentina. One hundred and two dementia caregivers from San Lucas, Argentina completed questionnaires assessing these constructs. Regressions found that caregiver burden, depression, anxiety, and satisfaction with life explained 18.8% of the variance in quality of care—respect and 14.7% of the variance in quality of care—provide. A structural equation model with generally adequate fit indices uncovered that cognitive functioning in individuals with dementia was inversely associated with caregiver burden, caregiver burden was inversely associated with mental health, and mental health was positively associated with quality of care. Further, patient cognitive functioning yielded a significant indirect effect on caregiver mental health through caregiver burden, as did burden on quality of care through mental health. Despite this negative cascade, these relationships may also be reversed with the development and use of dementia caregiver interventions that improve caregiver burden and mental health and as a result, the quality of care for individuals with dementia in Latin America.
pp. 766–779

Translating knowledge into practice: An exploratory study of dementia-specific training for community-based service providers
 Grace O’Sullivan; Clare Hocking; Kathryn McPherson

To develop, deliver, and evaluate dementia-specific training designed to inform service delivery by enhancing the knowledge of community-based service providers.
This exploratory qualitative study used an interdisciplinary, interuniversity team approach to develop and deliver dementia-specific training. Participants included management, care staff, and clients from three organizations funded to provide services in the community. Data on the acceptability, applicability, and perceived outcomes of the training were gathered through focus group discussions and individual interviews. Transcripts were analyzed to generate open codes which were clustered into themes and sub-themes addressing the content, delivery, and value of the training.
Staff valued up-to-date knowledge and “real stories” grounded in practice. Clients welcomed the strengths-based approach. Contractual obligations impact on the application of knowledge in practice.
The capacity to implement new knowledge may be limited by the legislative policies which frame service provision, to the detriment of service users.
pp. 780–796

Predicting perceived medication-related hassles in dementia family caregivers
Nika R George; Ann M Steffen;

This study examined predictors of medication administration hassles reported by intergenerational dementia family caregivers.
A sample of 53 women who aided a cognitively impaired older adult with healthcare and who identified as inter-generational caregivers provided self-report medication management and psychosocial data.
Future interventions may reduce medication-related hassles by providing psychoeducation about healthcare, medication management, and strategies for coping with care-related stressors and depressed mood.
 2015; pp. 797–810
Keady, M. J. (2017). [Review of the book Dementia: living in the memories of god, by John Swinton]. Dementia,
pp. 811–811

Withdrawn: An assessment of the dementia CQUIN – An audit of improving compliance
Mills, J., Minhas, J., & Robotham, S. (2013). An assessment of the dementia CQUIN – An audit of improving compliance. DOI: 10.1177/1471301213515575
The Department of Health has increased the emphasis on earlier detection of dementia among patients aged over 75 admitted to hospital in an emergency in England. Introduction of a Commissioning for Quality and Innovation (CQUIN) payment provides an incentive for NHS Trusts to screen patients for memory problems on admission. This article reports on how improvements were made to the screening process across three wards in a large university teaching hospital.

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