Living with a person with Alzheimer's disease: Experiences related to everyday occupations

The role of the social environment on dementia caregivers' pre-death grief: A mixed- methods systematic review

This systematic review examined the role of social environment in pre-death grief experiences of dementia caregivers. Ninety-three Chinese and English articles were included from a comprehensive search of empirical studies using nine databases. Six social environment domains were generated: the person with dementia, dyadic relationship, family members and the wider community, health and social care services, place of care, and social-cultural contexts. A complex interplay between caregivers and their social environments that aggravate and attenuate pre-death grief experiences is evident. Research has focused mainly on the effects of people with dementia and dyadic relationships and has paid modest attention to the effects of family, relatives, and health and social care services. Caregivers' experiences with their friends, fellow caregivers, the wider community, and social-cultural norms are influential but understudied. Future research could adopt a systems thinking approach with sociological perspectives to generate a comprehensive and nuanced understanding of pre-death grief experiences.

Daily time management in dementia: qualitative interviews with persons with dementia and their significant others

BACKGROUND

Persons with dementia encounter time-related problems and significant others often need to provide support in daily time management and use of time assistive technology (AT). Further research has been requested on how time AT for persons with dementia affects the situation of significant others. Moreover, there are a few previous qualitative studies on the experiences of time AT by persons with dementia. This study explores the experiences of persons with dementia and significant others in daily time management and their perceptions on how time AT affects everyday life.

METHOD

Semi-structured interviews with persons with mild to moderate dementia (n = 6) and significant others (n = 9) were conducted three months after receiving prescribed time AT. Interviews were analysed using qualitative content analysis.

RESULTS

A main category "Support by significant others is always part of daily time management", and three categories "Facing new challenges", "Using strategies to handle changes", and "Time assistive technology in daily life" illustrated that significant others provided support for daily time management in all phases of dementia. This support was often embedded in other kinds of support for emerging challenges. Support in time management was needed from an early stage in dementia, and responsibility for time management was gradually transferred to significant others. Time AT could support time orientation and were important for sharing the time management conducted by others but did not enable independent time management.

CONCLUSIONS

Time-related assessments and interventions should be offered at an early stage of dementia to increase the possibility of maintaining daily time management skills. Using time AT to communicate time might increase agency and participation in daily occupations for persons with dementia. Given the central role of significant others for daily time management, the society needs to adequately support persons with dementia lacking support from significant others.

A scoping review of family-centered interventions in dementia care

Families of persons living with dementia provide varying levels and forms of support to their loved ones and experience changes in familial dynamics, roles, and responsibilities over time. Family-centered care can enable their successful adaptation and participation in meaningful occupations. This scoping review aimed to explore available familycentered interventions for persons living with dementia, with a focus on occupational therapy. Three databases were searched and 31 eligible studies were found. Thirteen family-centered interventions were identified that were mostly multicomponent in nature, of which three involved occupational therapy. These interventions were investigated using a range of study designs and addressed outcomes related to the person with dementia, primary caregiver, and extended social network. With respect to study context, most interventions were developed in the United States and other Western countries with a limited number located in other contexts. The review findings underline the need for developing more family-centered interventions within occupational therapy, particularly for different contexts and cultures, and for translating available interventions to practice.

Supporting sustainable occupational lives for partner caregivers of people with dementia

Introduction

This qualitative research explores the experience of partner caregivers and how their partner’s dementia impacts on their daily living and occupational lives, with the aim of informing the sustainability of homecare and decreasing the likelihood of formal care.

Method

Ten participants were recruited through Alzheimer’s Society groups. They were interviewed using the same semi-structured interview process and asked questions about their daily activities and caregiving role. The data was analysed using Braun and Clarke’s thematic analysis process and themes generated using inductive coding and reasoning.

Findings

Three main themes were identified: (1) losing occupational activities and roles; (2) adapting to a new occupational life and (3) adjusting to a new relationship in the trajectory of their partner’s illness.

Conclusion

This study highlights the complex occupational challenges experienced by partner caregivers of people with dementia. It suggests that there is a role for occupational therapists in sustaining homecare by working with partner caregivers as ‘expert service users’. Involvement should be provided at critical points of the caregiving journey and include co-creating technology solutions for social inclusion, sustaining adaptive engagement in personal occupations, creating opportunities for restoration and supporting caregivers to preserve their partner’s personhood.

An occupational perspective of the lived experience of familial dementia caregivers: A thematic review of qualitative literature

Dementia caregiving is thought to have a negative impact on health and wellbeing. This critical review of qualitative literature explored the lived experience of familial dementia caregivers from an occupational therapy perspective. The method was informed by systematic review and qualitative research methodologies and was structured within the occupational dimensions framework of doing-being-becoming-belonging. A comprehensive search of major databases was undertaken which identified 484 studies on the topic; 14 met the inclusion criteria and were included in the review. Ten themes emerged within the doing-being-becoming-belonging framework from the analysis of the studies. The occupational participation of caregivers is conveyed within the 'doing' domain. Ways in which caregiving impacts upon opportunities for self-nurture are presented within the 'being' domain. The 'becoming' domain elucidates ways in which caregivers redefine themselves, their values and their priorities through their caregiving role. The 'belonging' domain depicts ways in which caregivers' connections with their care recipient and others are shaped over time. Practice implications for health and social care practitioners who work with familial dementia caregivers are presented in light of the findings.

How does a woman with Alzheimer’s disease make sense of becoming cared for?

This case study explores the meaning one woman with Alzheimer’s disease (AD) gives to receiving assistance with instrumental activities of daily living (IADLs) from her spouse. Improving the care of people living with AD is widely accepted as an important outcome in dementia services. Understanding how it feels for the person with AD to receive that care is essential to enhance their quality of life. Experiences identified using interpretative phenomenological analysis focus on a connection to past self and maintaining identity whilst also accepting change. The experience of ‘Sameness and Change’ identifies her feelings of discontinuity whilst ‘Goodness’ depicts her continued emotional expression of care presented in an attempt to remain someone of value within her family. These findings offer new insight and understanding to assist a woman’s transition from carer to becoming cared for.

Relationship and stage of dementia differences in caregiver perspectives on the meaning of activity

Caregivers of persons living with dementia (PWD) taking cholinesterase inhibitors, who care 3 + h over three days/week, were interviewed. This study uses thematic content analysis to compare responses to the open-ended question “ What do you believe getting involved in activities outside the home means for someone with dementia?” in spouse ( n = 613) and adult–children ( n = 260) caregivers, and across mild ( n = 314) and moderate–severe stages ( n = 280). For adult–children caregivers, activity participation promotes independence in their parents. Spouses describe activity in the context of their relationship with the PWD, and the experience is framed around their continued social roles as a couple. Mild-stage caregivers report the difficulty and negative outcomes (e.g. frustration, stigma) of engaging in activity, while moderate–severe caregivers discuss activity as preserving abilities in PWD and providing connection to cohort. This may indicate areas for improved activity provision and support for spouse (i.e. emotional) and adult–children (i.e. resources) caregivers across dementia stages.

Exploring the role of occupation for spouse-carers before and after the death of a spouse with dementia

Introduction

When a person with dementia dies, their former spouse-carer can find their personal resources so depleted that re-engaging in life can be difficult, leaving their mental health vulnerable. This qualitative study aimed to explore whether the occupations of spouse-carers contribute in the transition to the post-care period.

Method

Purposive sampling was used to recruit nine spouse-carers, who were between 1 and 5 years post-bereavement, via two branches of the Alzheimer’s Society, in the United Kingdom. In-depth interviews collected data for this interpretative phenomenological study, which were subject to template analysis.

Findings

Exploration of the data produced themes of continuity, roles and occupations, support and change and transition. Many of the findings supported published literature. However, a new finding emerged, where spouse-carers’ engagement in a ‘sustaining occupation’ (researcher’s term) appeared to counter the effect of role overload.

Conclusion

Four key ways that occupations of spouse-carers contributed to the transition to post-care were identified: ‘sustaining occupations’; occupations that maintain spouse-carers’ identity; continuing bonds with the deceased care-recipient; developing new roles. The first two of these began before bereavement and assisted in equipping spouse-carers for the transition to post-care. The second two followed bereavement and enabled spouse-carers to build confidence and re-engage with life.

Meaningful activity for persons with dementia: family caregiver perspectives

Dementia threatens the capacity to engage in activity, suggesting meaningful activity may be helpful for persons with dementia (PWDs). This study explores the concept of meaningful activity, as defined by caregivers of PWDs. Family caregivers of PWDs, who provide 3 hours of care over 3 days/week, were interviewed after 6 months of cholinesterase inhibitors (ChEIs) therapy. Caregiver responses (N = 906) to the open-ended question What do you believe getting involved in activities outside the home means for someone with dementia are assessed. The themes are analyzed in terms of content, frequency, co-occurrence, and dementia severity. Caregivers emphasize the benefits of social connectedness, physical health, and mental stimulation. Activity is also viewed as respite, difficult, and has no meaning for care recipient. The implications of activity for self- and social-identity in PWD and caregiver are discussed. The benefits of activity varied by stage of disease. This knowledge indicates areas for improved activity provision and health care support.

The Human Occupational Impact of Partner and Close Family Caregiving in Dementia: A Meta-Synthesis of the Qualitative Research, Using a Bespoke Quality Appraisal Tool

Introduction:

In 2009, the United Kingdom Department of Health identified the need to assist families so that people with dementia can remain living at home. Occupational therapists could support families and their loved ones at home by understanding the human occupational impact of caregiving. This impact includes how one is influenced by values and motivated to perform activities shaped by experiences and life roles. The purpose of this review was to synthesize qualitative research related to family dementia caregiving, extrapolating information about the human occupational impact on the caregiver. The aim was to inform occupational therapy practice.

Method:

A search was conducted across a range of electronic databases. A quality appraisal tool was specifically developed for the study appraisal and data extraction process. Data were extracted and analysed within the Model of Human Occupation framework.

Findings:

Twenty studies were included in this review. Five themes emerged: adapting to dementia; staying motivated and in control; preserving occupational balance and wellbeing; gaining meaning from the caregiver role; and losses and burden.

Conclusion:

The human occupational impact of caregiving affects the quality and decision-making of care for families. Occupational therapists are well placed to support families through the stages of dementia.

In the footsteps of Wilcock, Part two: The interdependent nature of doing, being, becoming, and belonging

The four dimensions of occupation developed by Wilcock in the Occupational Perspective on Health-doing, being, becoming, and belonging-have evolved. Although the inter-relationships between the dimensions have been explored by clinicians and researchers to some degree, the reciprocal and multidimensional nature of these relationships are rarely explicitly addressed. This article will present a critical analysis of the relationships and interaction between doing, being, becoming, and belonging, initially in dyads and then in a multidimensional way. The article proposes provisional understandings of how they combine and influence each other in occupational engagement. Six observations are made on the dimensions of occupation, along with a discussion of the impact of their interrelationships on research and practice.

Using meta-ethnography to understand the emotional impact of caring for people with increasing cognitive impairment

The majority of people with degenerative neurological conditions are cared for within their own families. Cognitive impairment can be a significant and increasing symptom of these conditions. In this article we report how a team of experienced researchers carried out a meta-ethnography of qualitative research articles focusing on the impact of caring for a loved one with cognitive impairment. We followed the seven-step process outlined by Noblit and Hare. Synthesized findings from 31 papers suggest emotional impact is complex and uncertain and varies from day to day. The benefit of using meta-ethnography is that the results represent a larger sample size and a reinterpretation of multiple studies can hold greater application for practice. The results of this study offer an opportunity for nurses to be aware of both the positive and negative sides of caring and being cared for. This knowledge can be used to discuss with patients and carers how best to prepare for decreasing cognition and still maintain a worthwhile quality of life.

Family caregivers' health in connection with providing care

Our aim was to investigate connections between Swedish family caregivers' health and providing care for an ill relative by conducting a systematic search and synthesis of previous research. We analyzed 31 articles using first qualitative content analysis then hermeneutic analysis. Analysis resulted in three derived themes-sliding sideways into caregiving, caregiving in reciprocity, and caregiving in disintegration-and a main interpretation and conceptual model of Swedish family caregivers' health-caregiving in a sphere of beliefs. Results indicated that Swedish family caregivers' beliefs, experiences of reciprocity, or nonsupport, together with quality of interpersonal relationships and feelings of responsibility and guilt, have a profound impact on their health. These results point to the value and importance of nurses gaining an understanding of family caregivers' beliefs and experiences of reciprocity or nonsupport to effectively promote family caregivers' health.

Care-givers’ perspectives of occupational engagement of persons with dementia

Meaningful engagement in activity is associated with the maintenance of health and wellbeing, but reduced activity participation is common among persons with dementia. Family care-givers play an important role in engaging their relatives with dementia in activities but little is known about their perception of occupational engagement. This study aimed to examine care-givers’ perception of occupational performance of their relatives from three aspects: person, occupation and environment. Adopting a qualitative methodology, semi-structured and in-depth interviews were conducted with 14 family care-givers. Care-givers were also asked to document the activity patterns of their relative, using the Activity Card Sort Hong Kong version (ACS-HK). The ACS-HK findings suggested that high-demand leisure activities were mostly retained (61%) while instrumental activities of daily living were the least retained (37%). Qualitative analysis revealed that care-givers’ perception of activity participation was intertwined with their motives and behaviours to get their relatives engaged in activities. Care-givers acknowledged occupational engagement as a means of maintaining wellness and used various strategies to encourage their relative's activity participation. Apathy and passivity, however, are difficult to deal with. Also, activity decisions appear to depend on the availability of support resources and a balance between safety concern and risk-taking. Clinical practitioners could assist care-givers by suggesting activity strategies and providing support resources for continued engagement of their relative in activities.

An international collaborative study comparing Swedish and Japanese nurses' reactions to elder abuse

AIM

This paper reports an analysis of aggregated data from two national studies on Swedish community-based nurses' and Japanese Public Health Nurses' responses to hypothetical elder abuse cases.

BACKGROUND

Elder abuse is an under-researched area despite being globally recognized as a serious and escalating problem. Yet research, adding needed socio-cultural perspectives to current knowledge has been limited.

METHODS

Eighty-one community-based nurses in Sweden and 124 Public Health Nurses in Japan responded to a questionnaire based on three hypothetical elder abuse cases. Swedish and Japanese results (data collection 2006-2007) were combined and the aggregated data were analysed using manifest and qualitative content analyses.

RESULTS

Nurses' response patterns in the aggregated data were similar across all three hypothetical cases and within themes Awareness, Assessment and Intervention. However, there were also noteworthy differences between Swedish and Japanese responses, e.g. Swedish responses were generally practical, action oriented and involved increased levels of suspicion and personal intervention to achieve increased control; whereas Japanese responses concerned better understanding that involved the family members and their situation, focusing on interventions grounded in collaboration.

CONCLUSION

Despite cultural differences, responses of Swedish and Japanese nurses were very similar which points to a global 'humanness' of the problem of, and nurses' responses to, elder abuse. Results endorse the value of international collaborations that give information and inspiration to nursing colleagues across cultural boundaries. Results also give hope that global tools for elder abuse assessment and intervention can be developed.

A Phenomenological Study of Volition in Everyday Occupations of Older People with Dementia

Aim:

The aim of this study was to understand volition in people with moderate dementia. The study provided an in-depth description and analysis of volition in eight older people in a memory-support assisted living unit.

Method:

Guiding questions focused on understanding past life interests, demonstration of volition, volitional continuity, and the relationship among the social environment, volition and daily occupations. Data collection included participant observation, family and staff interviews, and the Volitional Questionnaire. The Mini-Mental State Examination provided a measure of cognitive impairment.

Findings:

Three interacting themes emerged: variation in volitional expression, redefining meaningful occupation and potency of the social environment. The participants differed in volitional expression, showed changes in continuity between past and present interests, and tended to modify their occupations to match their abilities.

Conclusion:

The participants' lived experiences consistently reflected dynamism between the social environment and the person in volitional expression.