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Kårelind F, Finkel D, Zarit SH, Wijk H, Bielsten T, Johansson L. Post-diagnostic support for persons with young-onset dementia - a retrospective analysis based on data from the Swedish dementia registry SveDem. BMC Health Serv Res 2024; 24:649. [PMID: 38773535 PMCID: PMC11110303 DOI: 10.1186/s12913-024-11108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/14/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Approximately 3.9 million persons worldwide have young-onset dementia. Symptoms related to young-onset dementia present distinct challenges related to finances, employment, and family. To provide tailored support, it is important to gain knowledge about the formal support available for persons with young-onset dementia. Therefore, this paper aims to describe formal support for persons with young-onset dementia in Sweden and the factors influencing this support. METHODS This retrospective study used data on persons under 65 years of age (n = 284) from The Swedish Registry for Cognitive/Dementia Disorders (SveDem) between 2021 and 2022. SveDem was established to monitor the quality of dementia care in Sweden. Characteristics of participants were obtained, including age, sex, dementia diagnosis, MMSE, medications, accommodation, and care setting. Descriptive statistics and logistic regression were used to test for associations between participant characteristics and post-diagnostic support. RESULTS Information and educational support were usually offered to the person with young-onset dementia (90.1%) and their family (78.9%). Approximately half of the sample were offered contact with a dementia nurse (49.3%), counsellor (51.4%), or needs assessor (47.9%). A minority (28.5%) were offered cognitive aids. Six regression models were conducted based on participant characteristics to predict the likelihood that persons were offered support. Support was not predicted by age, sex, children at home, accommodation, or medications. Lower MMSE scores (p < .05) and home help (p < .05) were significantly associated with offer of a needs assessor. Living together was a significant predictor (p < .01) for information and educational support offered to the family. Care setting significantly predicted (p < .01) an offer of information and educational support for the person and family members, as well as contact with a counsellor. CONCLUSION This study indicates potential formal support shortages for persons with young-onset dementia in some areas of dementia care. Despite equal support across most characteristics, disparities based on care setting highlight the importance of specialised dementia care. Pre-diagnostic support is minimal, indicating challenges for persons with young-onset dementia to access these services before diagnosis. While our study has identified areas in need of improvement, we recommend further research to understand the changing support needs of those with young-onset dementia.
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Affiliation(s)
- Fanny Kårelind
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Deborah Finkel
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Center for Economic and Social Research, University of Southern California, Los Angeles, USA
| | - Steven H Zarit
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Human Development and Family Studies, Penn State University, University Park, USA
| | - Helle Wijk
- Institute of Health and Care Science, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Therese Bielsten
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Linda Johansson
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Faulkner T, Dickinson J, Limbert S, Giebel C. The experiences and perspectives of older adult mental health professional staff teams when supporting people with young-onset dementia. DEMENTIA 2024; 23:567-583. [PMID: 38441077 DOI: 10.1177/14713012241236106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background. The diagnosis of young-onset dementia presents significant challenges both for the person and their families, which often differ from the challenges faced with late-onset dementia. Evidence of the experience of service users and carers tends to reveal a negative appraisal of the care received, citing longer diagnosis times, poor clinician knowledge and lack of age-appropriate care. However, evidence looking into staff experiences of supporting someone with young-onset dementia is relatively scarce. The aim of this study was to explore the experiences and reflections of health and social care staff who support people with young-onset dementia within older adult mental health services, and whether their knowledge of the systems they work in could reveal the existence of barriers or facilitators to young-onset dementia care. Methods. Health and social care professionals working with people and carers with young-onset dementia across England were remotely interviewed between September and December 2021. Data were analysed using inductive thematic analysis. Findings. Sixteen staff members were interviewed. Three themes were constructed with six sub-themes. The first theme related to the perception of greater complexity around young-onset dementia support. The second theme describes staff fears around their ability to effectively support people with young-onset dementia, including the perception that young-onset dementia requires specialist input. The final theme describes systemic and structural inefficiencies which provide additional challenges for staff. Conclusions. Providing effective support for people with young-onset dementia and their families requires adjustments both within the clinician role and mental health services. Staff considered young-onset dementia support to be a specialist intervention and felt the services they work for are suited to generic mental health and dementia provision. Findings are discussed with recommendations relating to developing a standardised model of dementia care for young-onset dementia which recognises and responds to the unique experiences of young-onset dementia.
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Affiliation(s)
- Thomas Faulkner
- Mersey Care NHS Foundation Trust, UK
- NIHR Applied Research Collaboration North-West Coast, UK
| | | | - Stan Limbert
- NIHR Applied Research Collaboration North-West Coast, UK
| | - Clarissa Giebel
- NIHR Applied Research Collaboration North-West Coast, UK
- Department of Primary Care and Mental Health, University of Liverpool, UK
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Kogata T, Saito C, Kato F, Kudo J, Yamaguchi Y, Lee S, Washimi Y. An analysis of the contents of the young-onset dementia helpline: profiles of clients who consulted the helpline themselves. Psychogeriatrics 2024; 24:617-626. [PMID: 38433324 DOI: 10.1111/psyg.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Young-onset dementia (YOD) community care requires personalised approaches. Yet, the specific details of YOD consultations are unclear. This study explored how initial consultations correlate with client profiles. METHODS Data from regional YOD helplines were used to analyze the main characteristics of people living with YOD or who had concerns about the possibility of YOD (n = 132). Among several categorical variables, the following were used for analysis: age group, sex, type of living arrangement, employment status, presence of dementia, and content of the consultation. To identify groups of items that frequently occur together, strongly connected rules were identified using association rule analysis with the a priori algorithm. To focus on the characteristics of clients, rules related to client characteristics were extracted based on the type of consultation. RESULTS A total of 51 rules were identified for the consultations. These rules fell into two categories: (1) consultations for medical matters, which mainly involved employed individuals with undiagnosed dementia, and (2) other consultations on daily life or work, which mainly involved individuals diagnosed with dementia and were characterised by the influence of sex. These rules indicate the importance of medical involvement in confirming the diagnosis and specific individualised care following diagnosis for people living with YOD. CONCLUSION Clients with or without a dementia diagnosis were consulted differently in the YOD helplines. Before receiving a diagnosis, medical matters were the main theme of consultations, whereas after receiving a diagnosis, adjustments to daily life or work were the main themes. The results of this study suggest that the needs of people living with YOD and the services they require may vary depending on their backgrounds.
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Affiliation(s)
- Tomohiro Kogata
- Obu Centre for Dementia Care Research and Practices, Obu, Japan
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Chiaki Saito
- Obu Centre for Dementia Care Research and Practices, Obu, Japan
| | - Fukiko Kato
- Obu Centre for Dementia Care Research and Practices, Obu, Japan
| | - Jumpei Kudo
- Obu Centre for Dementia Care Research and Practices, Obu, Japan
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | | | - Sangyoon Lee
- Obu Centre for Dementia Care Research and Practices, Obu, Japan
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
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Smeets B, Janssen N, Peetoom K, Boots L, Bakker C, de Vugt M. 'Too young to sit at home': a qualitative study conducted among employees with young-onset dementia and their relatives. Aging Ment Health 2024:1-10. [PMID: 38669151 DOI: 10.1080/13607863.2024.2345132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Young-onset dementia (YOD) symptoms often first present in the workplace, resulting in work performance challenges and eventually loss of employment. This study aims to investigate the experiences, work values, and support needs of employees with YOD and their relatives. METHOD Semi-structured interviews were conducted to explore the experiences, work values, and support needs of (former) employees with YOD and their relatives. Subsequently, separate focus group discussions were conducted for employees and relatives to review and prioritize interview findings. Inductive thematic analysis was applied to both datasets. RESULTS A total of 15 interviews (six employees; nine relatives) and four focus group discussions (ten employees; six relatives) were conducted. Six themes emerged, with five revolving around the central theme: desire to work. The other themes represent essential contributing factors, including importance of receiving a YOD diagnosis; knowledge, awareness, and understanding regarding YOD; open communication, joint decision making, and collaboration; work adjustments, involvement, and support; phasing out work and future perspectives. CONCLUSION The findings highlight a strong desire to work post-YOD diagnosis, serving as a foundation for developing workplace support tools and guidance. This has the potential to help individuals with YOD preserve their self-confidence and identity while working within their capabilities.
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Affiliation(s)
- Bo Smeets
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Niels Janssen
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Lizzy Boots
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Christian Bakker
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
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Mitchell A, Kelso W, Paynter C, Hayes L, Velakoulis D, Loi SM. Peer Support for Caregivers of People Living with Posterior Cortical Atrophy in Melbourne, Australia: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:513. [PMID: 38673424 PMCID: PMC11050742 DOI: 10.3390/ijerph21040513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
Posterior Cortical Atrophy (PCA) is a rare form of young-onset dementia that causes early visuospatial and visuoperceptual deficits. The symptom profile of Posterior Cortical Atrophy leads to very specific care needs for those affected, who often rely on informal caregivers (including friends and family). Rare dementia support groups can be useful for both patients and their caregivers to assist with knowledge sharing, psychoeducation, and the provision of psychosocial support. Despite this, few such support groups exist. The purpose of this study was to examine a PCA support group for caregivers of individuals living with PCA. We held a structured psychoeducation support group comprised of four sessions with the aim being to provide education, strategies for the management of the disease, and peer support. Caregivers' mental health and quality of life were assessed. The results of our study showed that support group participation was a positive experience and assisted with increasing the knowledge of caregivers and fostering social connections. We suggest that peer support groups may be beneficial for both people living with PCA and their caregivers. We recommend that future quantitative and qualitative research is conducted to further assess health-promotion benefits to people living with PCA and their caregivers, and to assess their development and implementation in different contexts.
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Affiliation(s)
- Alexander Mitchell
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
| | - Wendy Kelso
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
| | - Camille Paynter
- Melbourne School of Health Sciences, University of Melbourne, Parkville 3052, Australia;
| | - Leanne Hayes
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
| | - Dennis Velakoulis
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
- Department of Psychiatry, University of Melbourne, Parkville 3052, Australia
| | - Samantha M. Loi
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
- Department of Psychiatry, University of Melbourne, Parkville 3052, Australia
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Tang X, Wang J, Wu B, Navarra AM, Cui X, Wang J. Lived experiences of maintaining self-identity among persons living with young-onset dementia: A qualitative meta-synthesis. DEMENTIA 2023; 22:1776-1798. [PMID: 37646673 DOI: 10.1177/14713012231193547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND The self-identity of persons with young-onset dementia (YOD) is affected by the disease progression. However, the lived experience of maintaining self-identity along the disease trajectory is understudied. This meta-synthesis integrated qualitative data on the challenges, coping strategies, and needs of persons living with YOD and how their experiences affected their self-identity over time. METHODS Four English (PubMed, Scopus, CINAHL, PsycINFO) and two Chinese (CNKI and Wanfang) electronic databases were searched for published literature peer-reviewed from the time of database inception to 2022. We used thematic analysis to extract and synthesize data from the literature concerning the long-term lived experiences of persons living with YOD. RESULTS A total of five peer-reviewed publications were eligible for inclusion in this meta-synthesis study. We identified four themes: (1) declining cognitive function and a prolonged diagnostic process threaten the self-identity of persons living with YOD, (2) struggling to accept the diagnosis of YOD and maintain self-identity, (3) maintaining self-identity and the normalcy of life through social support and person-centered care, and (4) living with YOD through self-development and self-identity reshaping at a later stage of the disease. CONCLUSIONS Persons living with YOD experience challenges maintaining their self-identity throughout the disease trajectory. These challenges are affected by their cognitive function, experiences of personal and social stigma associated with the disease, perceived social support, and person-centered care. Study findings have implications for developing tailored supportive programs for persons living with YOD at various stages of the disease trajectory.
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Affiliation(s)
| | | | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | | | - Jing Wang
- University of New Hampshire, College of Health and Human Services, Durham, NH, USA
- Fudan University, Shanghai, China
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Fox S. "Give me the knowledge, and I can do what I want with it, it's my right and my choice": Triangulated perspectives on the disclosure of young onset dementia. DEMENTIA 2023; 22:1757-1775. [PMID: 37505214 PMCID: PMC10644682 DOI: 10.1177/14713012231191958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Receiving a diagnosis of young onset dementia is particularly distressing; the person under 65 years is often in employment, with financial commitments, young children, and an active social life. Some of the stress experienced by younger people experiencing cognitive changes can be reduced by an early and accurate diagnosis, but this is contingent on the timing of disclosure and a process which is sensitive and appropriate to the person. The study aim was to explore experiences of giving and receiving a diagnosis of young onset dementia, by triangulating the perspectives of the key parties involved. METHODS A qualitative design was employed, using semi-structured interviews. Participants (N = 47) included people with young onset dementia (n = 10), family members (n = 12), and health and social care professionals (n = 25). Thematic analysis and triangulation enabled identification of overall themes across different participant groups. RESULTS All participant groups agreed on key aspects of good disclosure practice, with two overarching themes: The optimal conditions for disclosure, and how best to disclose a diagnosis. Positive experiences of disclosure were prefaced on having the appropriate space and time; having a support person present; clearly labelling the diagnosis; providing appropriate information at the right pace. Other findings include recommendations for longer appointment times, offering additional support for young families, and for carers of people with atypical presentations (e.g. frontotemporal dementia). CONCLUSION Many people with young onset dementia had unsatisfactory disclosure experiences. Health and social care professionals should provide a 'pre-disclosure' appointment, elicit the amount of information the person may want at the point of disclosure of the diagnosis, balance truth and hope, provide contact details for follow-up, and overall be mindful of the individual in front of them. While young onset dementia may be a life-altering diagnosis, a disclosure meeting which is sensitively undertaken can increase the person's agency, coping ability, and ultimately empower them to live well with their diagnosis.
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Affiliation(s)
- Siobhán Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Loi SM. Cessation of driving has important psychosocial implications for people living with young-onset dementia and their families. Evid Based Nurs 2023:ebnurs-2023-103832. [PMID: 37821209 DOI: 10.1136/ebnurs-2023-103832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Samantha M Loi
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Neuropsychiatry Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Lai M, Jeon YH, McKenzie H, Withall A. Journey to Diagnosis of Young-Onset Dementia: A Qualitative Study of People with Young-Onset Dementia and their Family Caregivers in Australia. DEMENTIA 2023:14713012231173013. [PMID: 37126513 DOI: 10.1177/14713012231173013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES This study aims to explore the journey to dementia diagnosis and reaction to the diagnosis from the perspective of people with young-onset dementia living in the community from diverse areas in Australia (metropolitan, regional, rural) and their family caregivers. METHODS Semi-structured interviews were conducted with community-dwelling people with early to moderate young-onset Alzheimer's disease (n = 8) or frontotemporal dementia (n = 5) and one person with both Alzheimer's disease and frontotemporal dementia, and family caregivers of community-dwelling people with young-onset Alzheimer's disease and/or frontotemporal dementia (n = 28). This study employed interpretive description. Thematic analysis was conducted for emergent themes, comparisons and interplay between themes. FINDINGS The journey to the diagnosis is characterised as involving an extensive period of the gradual worsening of symptoms, drawn out investigations, and difficulties facing the prospect of a diagnosis of young-onset dementia. Participants with young-onset dementia struggled to manage their symptoms and the process of seeking a diagnosis was often slow due to difficulties during the course of their medical investigations and feeling reluctance to face the possibility of having dementia. Once participants finally received the diagnosis of young-onset dementia, participants with young-onset dementia and their family caregivers experienced feelings of devastation and shock, in some cases denial and avoidance, and even, confirmation and relief at having received a diagnosis. In some instances, participants experienced more than one of these reactions. There was a profound realisation by participants that a diagnosis of young-onset dementia had serious implications on their life and future. CONCLUSION The journey to diagnosis was found to be a drawn-out process and receiving the diagnosis was a shock for both people with young-onset dementia and their family caregivers. The findings highlight the significance of the role healthcare professionals play in both the diagnostic and post-diagnostic journey, particularly in terms of supporting patients with young-onset dementia and their family caregivers.
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Affiliation(s)
- Michelle Lai
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Heather McKenzie
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Adrienne Withall
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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Aspö M, Visser L, Kivipelto M, Boström AM, Cronfalk BS. Transitions: Experiences of younger persons recently diagnosed with Alzheimer-type dementia. DEMENTIA 2023; 22:610-627. [PMID: 36730720 PMCID: PMC10009323 DOI: 10.1177/14713012231155516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Receiving a diagnosis of dementia before the age of 65 has a huge impact on everyday life. Previously, the disease trajectory has mainly been described from the perspective of older persons. However, young persons with dementia are confronted with specific challenges, influencing the type of life-changing events, or 'critical points' that they may experience. The aim of this study was therefore to describe experiences of persons recently being diagnosed with young-onset dementia. In total, 14 participants with dementia due to Alzheimer's disease (10 woman/4 men) with an average age of 59 were included in the study. Interviews were conducted within 2 months after receiving the diagnosis and analyzed using qualitative content analysis with an inductive approach, resulting in three categories: (1) A life changing moment, (2) An ongoing process, and (3) Remaining in control. The findings show that receiving such a diagnosis was experienced by participants as a life changing moment, followed by them seeking to come to terms with the diagnosis and reflecting on its meaning, in which various strategies were adopted to remain in control. The current study highlights three critical points considering the diagnosis of young-onset dementia that warrant special attention and provides insight into factors related to delay in healthy transitioning after receiving the diagnosis, as well as factors that may facilitate successful transitions.
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Affiliation(s)
- Malin Aspö
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, 27106Karolinska Institutet, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Sweden
| | - Leonie Visser
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, 27106Karolinska Institutet, Sweden; Department of Medical Psychology, 522567Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | - Miia Kivipelto
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, 27106Karolinska Institutet, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Sweden; Department of Research and Development, Stockholms Sjukhem Foundation, Sweden
| | - Anne-Marie Boström
- Theme Inflammation and Aging, Karolinska University Hospital, Sweden; Department of Research and Development, Stockholms Sjukhem Foundation, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, 27106Karolinska Institutet, Sweden
| | - Berit S Cronfalk
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, 27106Karolinska Institutet, Sweden; Department of Health Sciences, 7666Red Cross University College, Sweden
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Lin Z, Tang D, Stamou V, LaFontaine J, Oyebode J, Parkes J. Receiving a diagnosis of young onset dementia: a scoping review of lived experiences. Aging Ment Health 2023; 25:1-12. [PMID: 31647324 PMCID: PMC9226199 DOI: 10.1080/13607863.2019.1673699] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Personal experiences of receiving a diagnosis of young onset dementia (YOD) are often overlooked in a complex assessment process requiring substantial investigation. A thematic synthesis of published until November 2018 qualitative studies was completed to understand the lived experiences of younger people. This informed a Delphi study to learn how diagnostic processes could be improved, identify the strengths and weaknesses of current approaches, and help educate professionals concerning key issues. METHOD Systematic searches of bibliographic databases were conducted involving self-reported experiences of diagnosis of YOD. Eight out of 47 papers identified were quality assessed using Walsh & Browne's criteria for methodological appraisal. RESULTS The review emphasises that delays in diagnosis can often be attributed to (1) delays in accessing help, and (2) misattribution of symptoms by the clinician. The impact of diagnosis is influenced by the clinician's use of language; and reactions to diagnosis varied from feelings of reassurance (in that their symptoms are now explained), to shock and destabilisation. CONCLUSION This review suggests that improving the recognition of presenting symptoms, reducing diagnostic errors, and identifying the emotional needs arising from diagnosis are required to improve the diagnostic experience for younger adults, and to promote future engagement with services.
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Affiliation(s)
- Zhiyong Lin
- Center on Aging and Population Sciences and Population Research Center, The University of Texas at Austin, Austin
| | - Dan Tang
- Address correspondence to: Dan Tang, Population Development Studies Center, Renmin University of China.
| | - Vasileios Stamou
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jenny LaFontaine
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jacqueline Parkes
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
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Good practice in needs-based post-diagnostic support for people with young onset dementia: findings from the Angela Project. AGEING & SOCIETY 2023. [DOI: 10.1017/s0144686x22001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abstract
Evidence on post-diagnostic support for people with young onset dementia is scarce. Previous studies have employed a problem-focused approach; however, evidence on ‘what works’ in real-life practice is essential to develop recommendations for service design and delivery. This study aimed to provide insight into ‘what works’ from the perspectives of people with young onset dementia and their supporters. We gathered free-text responses on positive service experiences via a UK cross-sectional survey. Inductive thematic analysis was used to identify the objectives of positive services and the needs these met. Follow-up interviews enabled in-depth insights from people with diverse diagnoses, ages and social situations. These were analysed using a template drawn from the survey. The 233 survey respondents gave 856 examples of positive support. Analysis of 24 follow-up interviews led to 16 themes clustered under three superordinate themes: ‘maintaining autonomy’, ‘being myself’ and ‘togetherness’. We found that positive services address the disruptions to sense of agency, selfhood and meaningful relationships that are experienced by those with young onset dementia. The study provides an in-depth understanding of the needs met by positive services for younger people with dementia. Our nuanced findings on good practice can inform age-specific guidelines for young onset dementia and indicate how personalisation can work in practice to help people with young onset dementia to maintain identity, autonomy and connections.
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Abstract
BACKGROUND People with young onset dementia can experience stigmatization and social isolation. Peer support provides an opportunity for social connection and support. However, access to in-person peer support groups varies across the UK, and during the COVID-19 pandemic in-person peer support groups moved online. OBJECTIVES We explored the experiences of people with young onset dementia attending peer support meetings through online videoconferencing platforms, and identified barriers and facilitators. METHODS A focus group study with existing peer support groups for people with young onset dementia that had their meetings online was conducted. Participants were people living with young onset dementia. Participants were recruited through convenience and purposeful sampling. Initial contact was made with the group facilitator to discuss the study purposes and assess eligibility of the group members. The data was analysed thematically by two independent researchers, using an inductive approach. FINDINGS Four focus groups with UK-based peer support groups were conducted through the group's usual platform, including 20 participants. Through online peer support people stayed connected during the pandemic. It provided opportunities to meet people from different places and be involved in research projects. People found it a convenient way of connecting with others without having to travel. However, some missed in-person interaction and digital exclusion and challenges to navigate different platforms were identified as barriers. Organisational skills of the facilitator and support with getting into meetings can help overcome these challenges. CONCLUSION Online platforms can make peer support more accessible for people with young onset dementia as it overcomes geographical barriers as well as barriers for those who feel uncomfortable attending an in-person group. Researchers and policy makers should explore how to implement and overcome barriers to online peer support, so that peer support is more widely accessible and clearly signposted to people with young onset dementia.
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Affiliation(s)
- Esther Vera Gerritzen
- Esther V Gerritzen, Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham NG7 2TU, UK.
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Kilty C, Cahill S, Foley T, Fox S. Young onset dementia: implications for employment and finances. DEMENTIA 2023; 22:68-84. [PMID: 36254673 PMCID: PMC9772889 DOI: 10.1177/14713012221132374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND People with young onset dementia face unique challenges. Notably, at time of symptom presentation, many people affected by young onset dementia are still employed with significant financial obligations. The aim of this study was to explore the specific impact that young onset dementia has on continued employment and finances and to identify ways to optimise post-diagnostic approaches in this regard. METHODS Purposive sampling, with a maximum variation technique, was used to recruit a small but diverse range of people with young onset dementia in Ireland. In-depth semi-structured interviews were conducted, and data were analysed using Reflexive Thematic Analysis. In total, 22 interviews were conducted with 10 people with young onset dementia and 12 spouses and children. Two themes were constructed: impact of young onset dementia on (I) employment and (II) finances. FINDINGS Participants' lived accounts showed the devastating effect of a diagnosis of young onset dementia on working life, and the resultant financial, social, and psychological consequences. Participants reported having to leave paid employment early, reported losing contracts and retiring on medical grounds. There were financial implications caused by loss of income, and many additional expenses owing to dementia were incurred. In some families, spouses had to take up employment at the same time as a caring role to mitigate the loss of income, and young children were anxious at the resultant occupational and financial tensions. CONCLUSION People diagnosed with young onset dementia encounter significant challenges associated with employment, and individual and family finances. There is a need for more specific information and guidance from healthcare professionals around employment rights, income support and welfare benefits and the pension status for this group of people. Additionally, healthcare professionals should be cognisant of the additional financial burden people face in young onset dementia when advising on services which incur out-of-pocket costs.
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Affiliation(s)
- Caroline Kilty
- Caroline Kilty, School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland.
| | - Suzanne Cahill
- School of Social Work and Social Policy, Trinity College Dublin Centre for Economic and Social Research on Dementia, NUI Galway and Institute of Gerontology, Jonkoping University, Sweden
| | - Tony Foley
- Department of General Practice, 8795University College Cork, Republic of Ireland
| | - Siobhán Fox
- Centre for Gerontology and Rehabilitation, 8795University College Cork, Republic of Ireland
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O’Malley M, Parkes J, Stamou V, LaFontaine J, Oyebode J, Campbell J, Carter J. Current UK clinical practice in diagnosing dementia in younger adults: compliance with quality indicators in electronic health records from mental health trusts. Aging Ment Health 2022; 26:2233-2242. [PMID: 34473006 PMCID: PMC9621100 DOI: 10.1080/13607863.2021.1969640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To examine current UK practice in diagnosis of patients under 65 with young onset dementia, within 5 years of date of diagnosis, identified from electronic health records of 8 NHS mental health trusts. METHODS Patients diagnosed with young onset dementia were assembled from the UK-Clinical Record Interactive System, (UK-CRIS) using diagnosis of dementia as the index date. A pre-designed proforma, derived by international Delphi consensus from experts in the field in previous work, was used to assess components of the diagnostic assessment in 402 electronic health records across 8 NHS sites. Information was extracted on key aspects of clinical and physical examination according to both a minimum and gold standard. RESULTS Percentage compliance rates analysed by NHS site and statement, including compliance for site for minimum standard (11 statements), the additional 20 statements required for Gold standard, and the complete Gold standard set (31 statements) show that the additional 20 statements in the Gold standard had consistently higher compliance rates for every site compared to the minimum set. CONCLUSION Findings confirmed variation in clinical practice and identified commonly missed items in examination and enquiry compared to expert consensus. This suggests that a template proforma, which contains the key indicators for comprehensive assessment of dementia in young adults according to a quality standard could help support clinicians to improve record keeping and reduce gaps in knowledge.
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Affiliation(s)
- Mary O’Malley
- School of Biomedical Sciences, University of West London, Ealing, UK
| | - Jacqueline Parkes
- UoN Dementia Research & Innovation Centre, Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Vasileios Stamou
- Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| | - Jenny LaFontaine
- Faculty of Health Studies, Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jan Oyebode
- Faculty of Health Studies, Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jackie Campbell
- UoN Dementia Research & Innovation Centre, Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Janet Carter
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK,CONTACT Janet Carter
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Lo KC, Bricker-Katz G, Ballard K, Piguet O. The affective, behavioural, and cognitive reactions to a diagnosis of Primary Progressive Aphasia: A qualitative descriptive study. DEMENTIA 2022; 21:2476-2498. [PMID: 36054090 DOI: 10.1177/14713012221124315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Receiving a diagnosis of neurodegenerative disorder is life changing. Primary progressive aphasia is one such disease. Understanding how receiving this diagnosis impacts on individuals may help plan support services. However, limited qualitative research from the perspectives of people with Primary Progressive Aphasia are available for suitable care planning. Current literature primarily focuses on experiences of family members. The present study aims to fill this gap by examining the affective, behavioural, and cognitive experiences of people with Primary Progressive Aphasia. METHODS Semi-structured interviews were conducted with six participants with PPA. A qualitative descriptive approach was used to describe responses from participants on: (i) what they experienced prior to receiving their diagnosis; (ii) their experience of receiving the diagnosis; and (iii) how they were living with their PPA. Verbatim transcripts were analysed using thematic analysis to identify main themes. RESULTS Analysis revealed a superordinate theme of Multifaceted Grief with subthemes described in sequence of research questions posed, representing the three phases of Pre-Diagnosis, Time of Diagnosis, and Post-Diagnosis. Themes collectively revealed participants' ongoing experience of loss in dealing with the evolving challenges of Primary Progressive Aphasia. Experiences of loss emerged with descriptions of feelings, thoughts, and limitations in relation to changes imposed by the illness, impacting daily activities and life roles central to participants' pre-diagnosis sense of self. CONCLUSION Participants' affective, behavioural and cognitive reactions to their Primary Progressive Aphasia diagnosis marks the onset of Multifaceted Grief borne of loss of communication and cognition. Participants expressed a need for information regarding a possible Primary Progressive Aphasia trajectory and support to enable a successful transition as their disease progressed. Collaborative engagement between speech pathologists and people with Primary Progressive Aphasia incorporates addressing all levels of the International Classification of Functioning and Health by considering neurological, psychological, and psychosocial experiences of the person with the diagnosis.
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Affiliation(s)
- Kang-Chi Lo
- Discipline of Speech Pathology, Faculty of Medicine and Health, 4334University of Sydney, Sydney, NSW, Australia
| | - Geraldine Bricker-Katz
- Discipline of Speech Pathology, Faculty of Medicine and Health, 4334University of Sydney, Sydney, NSW, Australia
| | - Kirrie Ballard
- Discipline of Speech Pathology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; School of Psychology and Brain & Mind Centre, 4334 The University of Sydney, Sydney, NSW, Australia
| | - Olivier Piguet
- School of Psychology and Brain & Mind Centre, The University of Sydney, 4334Sydney, NSW, Australia
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17
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Huizenga J, Scheffelaar A, Fruijtier A, Wilken JP, Bleijenberg N, Van Regenmortel T. Everyday Experiences of People Living with Mild Cognitive Impairment or Dementia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10828. [PMID: 36078544 PMCID: PMC9518176 DOI: 10.3390/ijerph191710828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Increasing attention has been paid to the 'voice' of people living with mild cognitive impairment (MCI) or dementia, but there is a lack of clarity about how everyday life is perceived from this insider's perspective. This study aimed to explore the everyday life experiences, challenges and facilitators of individuals with MCI and dementia living at home. A scoping review of qualitative studies, guided by the Joanna Briggs Institute Reviewers Manual, was conducted. Eight databases were searched, resulting in 6345 records, of which 58 papers published between 2011 and 2021 were included. Analysis was carried out by descriptive content analysis. Findings were categorized into seven spheres of everyday life: experiences related to the condition, self, relationships, activities, environment, health and social care and public opinions. The results show many disruptions and losses in everyday life and how people try to accommodate these changes. In all areas of everyday life, people show a deep desire to have reciprocal relationships, stay engaged through participation in activities and have a sense of belonging in the community. However, more research is needed on the factors that promote and impede the sense of reciprocity and belonging.
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Affiliation(s)
- Jacoba Huizenga
- Institute of Social Work, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Aukelien Scheffelaar
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Agnetha Fruijtier
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
| | - Jean Pierre Wilken
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Research Center Healthy & Sustainable Living, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Department Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Tine Van Regenmortel
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
- HIVA—Research Institute for Work and Society, Faculty of Social Sciences, University of Leuven, B-3000 Leuven, Belgium
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18
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Poole C, Patterson TG. Experiences and Needs of Children Who Have a Parent with Young Onset Dementia: A Meta-ethnographic Review. Clin Gerontol 2022; 45:750-762. [PMID: 32496888 DOI: 10.1080/07317115.2020.1765933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: The aim of the present review was to critically evaluate empirical evidence regarding the needs and experiences of children who have a parent with young onset dementia (YOD).Methods: A systematic search of five databases was carried out and the resulting 16 studies were reviewed using a meta-ethnographic approach.Results: Three main themes arose from the data: 'Dementia Impact", which describes how the child experiences the deterioration in their parent and changes to relationships; "Psychological Impact", comprising the child's private emotional experiences and the psychological consequences of changes in roles; and "Practical Impact", detailing the ways in which children adapt their lives in response to parental YOD, and children's needs for support.Conclusions: These themes synthesize the existing literature and produce a line of argument explaining the experience of children whose parents have YOD.Clinical Implications: Information and policies regarding YOD should take account of the experiences of patients' children and should include targeted support for children of parents with YOD.
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Affiliation(s)
- Courtney Poole
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Tom G Patterson
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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20
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Gerritzen EV, McDermott O, Orrell M. Towards the development of a best practice guidance on online peer support for people with Young Onset Dementia: a mixed-methods study protocol (Preprint). JMIR Res Protoc 2022; 11:e38379. [PMID: 35788470 PMCID: PMC9297145 DOI: 10.2196/38379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Esther Vera Gerritzen
- Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Orii McDermott
- Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Martin Orrell
- Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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21
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Bruinsma J, Peetoom K, Bakker C, Boots L, Verhey F, de Vugt M. 'They simply do not understand': a focus group study exploring the lived experiences of family caregivers of people with frontotemporal dementia. Aging Ment Health 2022; 26:277-285. [PMID: 33325262 DOI: 10.1080/13607863.2020.1857697] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Frontotemporal dementia (FTD) has a profound impact on the spouse and other family caregivers involved. While caregivers have a need for support, it is difficult for healthcare providers to respond to their specific needs. This qualitative study explores the lived experiences and needs of caregivers of persons with FTD to facilitate the development of support. METHODS Three focus group discussions were organized to explore the lived experiences of Dutch FTD caregivers. The included caregivers (n = 24) were aged 16 years or older and were involved in the care of a relative with FTD. Two researchers independently performed an inductive content analysis using open and axial coding. RESULTS The main category emerging from the data was a lack of recognition, acknowledgment, and understanding experienced by caregivers. This was linked to caregivers' experiences with (1) complex emotional and behavioral symptoms in the person with FTD, (2) the trivializing responses of family and friends, (3) a perceived lack of knowledge and support from healthcare professionals, and (4) the bureaucratic procedures that accompany caregiving. As a result, caregivers felt lonely and solely responsible for the caregiving role. CONCLUSION Caregivers of persons with FTD experience a lack of understanding in caring for their relative with FTD, which contributes to feelings of loneliness. A specialized support approach is needed to address the specific needs of caregivers of persons with FTD. Support should address strategies that caregivers can use to inform and involve family and friends in the caregiving situation to prevent loneliness in FTD caregivers.
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Affiliation(s)
- Jeroen Bruinsma
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,Centre for Specialized Geriatric Care, Groenhuysen, Roosendaal, the Netherlands
| | - Lizzy Boots
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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22
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Popok PJ, Reichman M, LeFeber L, Grunberg VA, Bannon SM, Vranceanu AM. OUP accepted manuscript. THE GERONTOLOGIST 2022; 62:1311-1323. [PMID: 35442443 PMCID: PMC9579459 DOI: 10.1093/geront/gnac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Young-onset dementias (YODs) are a set of progressive illnesses that are stressful for both persons with the diagnosis and their care-partners. Although the stressors differ based on their roles and individual experiences, both individuals are at risk for heightened emotional distress (e.g., depression and anxiety). Understanding the unique stressors for each partner and adaptive coping strategies to manage these stressors is important for informing individual and couples-based psychosocial interventions. RESEARCH DESIGN AND METHODS We conducted open-ended individual interviews with persons with YOD (N = 12) and their care-partners (i.e., romantic partner; N = 17) over live video. We utilized a hybrid of deductive and inductive analysis techniques to extract individual-level themes and subthemes regarding stressors and adaptive coping strategies. RESULTS Persons with YOD identified stressors including burden of YOD symptoms, loss of familial roles, resentment toward partner, isolation, and fear of the future. Care-partners identified stressors including managing their partners' symptoms, increased responsibilities, caregiving role, loss of intimacy, social isolation, and grief. For adaptive coping strategies, persons with YOD endorsed use of acceptance, promotion of independence, social support, and engaging in pleasurable activities. Care-partners endorsed value of learning about the diagnosis, using resources, optimism, social support, and self-care. DISCUSSION AND IMPLICATIONS Findings highlight the unique experiences of persons with YOD and their care-partners. Identified themes can be used to inform role-specific psychosocial interventions for both individuals and couples coping with YOD.
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Affiliation(s)
- Paula J Popok
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lisa LeFeber
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Victoria A Grunberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah M Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ana-Maria Vranceanu
- Address correspondence to: Ana-Maria Vranceanu, PhD, Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA 02114, USA. E-mail:
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23
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Bannon SM, Reichman MR, Wang K, Uppal S, Grunberg VA, Vranceanu AM. A qualitative meta-synthesis of common and unique preferences for supportive services among persons with young onset dementia and their caregivers. DEMENTIA 2021; 21:519-539. [PMID: 34610764 DOI: 10.1177/14713012211048118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Young onset dementias (young onset dementia) produce a myriad of stressors for persons with young onset dementia and their caregivers, yet there is a critical shortage of supportive services that address their needs. To develop such services, it is necessary to first comprehensively understand persons' with young onset dementia and their caregivers' service preferences. Therefore, we conducted a meta-synthesis to integrate and summarize qualitative data on persons' with young onset dementia and caregivers' preferences for supportive services for young onset dementia, defined as support provided by medical providers, psychosocial interventions, and any other resources/services provided to promote positive adjustment in persons with young onset dementia and their caregivers. RESEARCH DESIGN AND METHODS We searched five electronic databases for qualitative articles from inception to January 2020. We extracted and synthesized data from eligible articles using thematic analysis. After removal of duplicates, we screened 219 articles identified through database and hand searches. FINDINGS Forty-three studies met our inclusion criteria. We extracted findings from these 43 studies on preferences within three a priori defined domains: 1) general characteristics of supportive services, 2) format and modality of supportive services, and 3) content for supportive services. Persons with young onset dementia and caregivers predominantly expressed common preferences, with some unique preferences based on their specific roles within the partnership. DISCUSSION AND IMPLICATIONS Persons with young onset dementia and their caregivers endorsed largely overlapping preferences, including having direct contact with providers and the ability to participate together in programs that have content and skills relevant to their specific needs and challenges. Findings can directly inform the format, content, and procedures of supportive services for persons with young onset dementia and their caregivers.
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Affiliation(s)
- Sarah M Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
| | - Mira R Reichman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
| | - Katherine Wang
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
| | - Simrit Uppal
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
| | - Victoria A Grunberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
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"Sometimes Life Throws You a Curve Ball": The Lived Experiences of an Individual With Early-Onset Alzheimer's Disease and His Family. CLIN NURSE SPEC 2021; 35:318-326. [PMID: 34606212 DOI: 10.1097/nur.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Individuals with early-onset Alzheimer's disease face many challenges and barriers older adults with late-onset Alzheimer's do not. Unfortunately, information about early-onset Alzheimer's disease is in its infancy stage in comparison with late-onset Alzheimer's. PURPOSE/AIMS The purpose of this study was to examine the lived experiences of a 54-year-old man with early-onset Alzheimer's disease and his family (wife, sister, and mother) to understand the effects on the family unit. DESIGN Interpretive phenomenology was used to guide this study. METHODS All participants completed 2 in-person one-on-one interviews, and a final interview was completed online. Field notes, member checks, and triangulation were used to enhance the study's credibility. RESULTS This article focuses on the theme "'A big curve ball': Disruption of the life cycle." Participants indicated the major financial and social challenges experienced by Joe and his wife. Furthermore, participants emphasized the importance of acceptance and maintaining a positive attitude to help cope with Joe's diagnosis. CONCLUSIONS The accounts of Joe and his family shed light on an area relatively void in the literature. In addition, Joe's experiences may provide comfort for other families facing early-onset Alzheimer's disease. The implications for community health nurses in assisting individuals with early-onset Alzheimer's disease and their families are discussed.
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Li X, Keady J, Ward R. Neighbourhoods and dementia: An updated realist review of the qualitative literature to inform contemporary practice and policy understanding. DEMENTIA 2021; 20:2957-2981. [PMID: 34098765 DOI: 10.1177/14713012211023649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This realist review of the literature provided a contemporary understanding of neighbourhoods and dementia and described how people living with dementia and their neighbourhood interacted via ongoing place-making and remaking processes. Drawing on 44 articles, neighbourhoods were revealed to have fluid and dynamic qualities where people with dementia used their strength and resources to connect to significant people and places. The review also indicated that the person with dementia-neighbourhood relationship was underpinned by four themes: 'home', 'social interactions', 'activities' and 'transportation'. Further research is encouraged to use innovative, participatory methods to explore the neighbourhood-dementia nexus in depth whilst paying close attention to social inclusion and diversity.
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Affiliation(s)
- Xia Li
- 13985National Institute for Health and Care Excellence, Manchester, UK
| | - John Keady
- University of Manchester, Manchester, UK
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Stamou V, Fontaine JL, O'Malley M, Jones B, Gage H, Parkes J, Carter J, Oyebode J. The nature of positive post-diagnostic support as experienced by people with young onset dementia. Aging Ment Health 2021; 25:1125-1133. [PMID: 32067481 DOI: 10.1080/13607863.2020.1727854] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Studies on service needs of people with young onset dementia have taken a problem-oriented approach with resulting recommendations focusing on reducing service shortcomings. This study aimed to build on 'what works' in real-life practice by exploring the nature of post-diagnostic support services that were perceived positively by younger people with dementia and carers. METHOD Positive examples of support were gathered between August 2017 and September 2018, via a national survey. Inductive thematic analysis was employed to explore the nature of positively experienced services provided for younger people with dementia, including analysis of what was provided by positively experienced services. RESULTS Two hundred and thirty-three respondents reported 856 positive experiences of support. Data analysis yielded eight themes regarding the objectives of positive services: Specialist Advice and Information on Young Onset Dementia, Access to Age-appropriate Services, Interventions for Physical and Mental Health, Opportunities for Social Participation, Opportunities to Have a Voice, Enablement of Independence while Managing Risk, Enablement of Financial Stability, and Support Interventions for Family Relationships. CONCLUSION The study findings (a) suggest that positive services may collectively create an enabling-protective circle that supports YPD to re-establish and maintain a positive identity in the face of young onset dementia, and (b) provide a basis from which future good practice can be developed.
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Affiliation(s)
- Vasileios Stamou
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Jenny La Fontaine
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Mary O'Malley
- The UoN Dementia Research & Innovation Centre, Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Bridget Jones
- Surrey Health Economics Centre, Department of Economics, University of Surrey, Guildford, Surrey, UK
| | - Heather Gage
- Surrey Health Economics Centre, Department of Economics, University of Surrey, Guildford, Surrey, UK
| | - Jacqueline Parkes
- The UoN Dementia Research & Innovation Centre, Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Janet Carter
- Division of Psychiatry, Faculty of Brain Sciences, Maple House, University College London, London, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
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Bruinsma J, Peetoom K, Bakker C, Boots L, Millenaar J, Verhey F, de Vugt M. Tailoring and evaluating the web-based 'Partner in Balance' intervention for family caregivers of persons with young-onset dementia. Internet Interv 2021; 25:100390. [PMID: 33996507 PMCID: PMC8102413 DOI: 10.1016/j.invent.2021.100390] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED Young-onset dementia (YOD) poses specific challenges for caregivers involved. However, most available support does not address their specific needs. Previously, the web-based Partner in Balance intervention showed promising results and facilitated role adaptation in dementia caregivers. Although the web-based format proved a good fit for YOD caregivers, the evaluation showed a need for tailored content on YOD. Therefore, new content was iteratively developed respectively for spouses and other family caregivers of persons with YOD. This study evaluates how caregivers perceived the tailored content. METHODS A pre-post design was used to prospectively evaluate how end-users perceived two tailored versions of the Partner in Balance intervention, one for spouses and one for other family members of people with YOD. After the intervention, participants were interviewed for approximately 60 min in-person or by telephone using the Program Participation Questionnaire. A qualitative deductive content analysis was used to evaluate (1) usability, (2) feasibility and acceptability, (3) perceptions on intervention content. To evaluate if the intervention facilitated role adaptation, preliminary effects were examined using pre-post questionnaires on self-efficacy, mastery, stress, anxiety and depression. RESULTS Spouses (n = 11) and other family members (n = 14) both positively evaluated the tailored content on YOD and valued that the web-based approach could easily be integrated in daily life. Participants perceived the intervention as usable, feasible and acceptable. Participants valued the recognizability of the content. Goal-setting helped participants to translate the intervention to daily life, although for some participants setting goals was difficult. Caregivers of persons with frontotemporal dementia suggested incorporating specific content to further increase recognizability. After participation, participants felt better equipped for the caregiving role. In line with previously demonstrated effects on generic modules of Partner in Balance, the tailored version increased levels of self-efficacy in the group of other family caregivers, t(12) = 3.37, p = .006. CONCLUSION The tailored Partner in Balance intervention was positively evaluated by YOD caregivers. Offering participants more guidance on goal-setting and adding content about frontotemporal dementia may facilitate implementation.
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Affiliation(s)
- Jeroen Bruinsma
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Christian Bakker
- Department of Primary and Community care, Radboud University Medical Centre, Nijmegen, the Netherlands,Radboudumc Alzheimer Centre, Nijmegen, the Netherlands,Groenhuysen, Centre for Specialized Geriatric Care, Roosendaal, the Netherlands
| | - Lizzy Boots
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | | | - Frans Verhey
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Corresponding author at: Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, P.O. UNS.40 box 616, 6200 MD Maastricht, the Netherlands.
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Bayly M, O'Connell ME, Kortzman A, Peacock S, Morgan DG, Kirk A. Family carers' narratives of the financial consequences of young onset dementia. DEMENTIA 2021; 20:2708-2724. [PMID: 33877946 PMCID: PMC8670747 DOI: 10.1177/14713012211009341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Individuals with young onset dementia and their families face unique challenges, such as disruptions to their life cycle and relationships and a dearth of appropriate supports. Financial consequences have also been noted in the literature yet have not been explored in-depth. The purpose of this research was to qualitatively explore carers’ experiences of financial consequences resulting from the young onset dementia of a family member and how these consequences may be managed. Eight carers (7 women and 1 man) provided a written online narrative about their journey with young onset dementia and any financial consequences experienced, with open-ended prompts to elicit details not yet shared. Narratives were inductively coded and analyzed using a thematic narrative approach. Carers described a voluntary or involuntary end to employment for the person with young onset dementia around the time of diagnosis. This engendered ongoing and anticipated financial consequences, combined with the need for carers to balance employment with the provision of care (which often meant early retirement for spousal carers). Common themes were tension between the needs to provide care and earn income, altered financial prospects, costs of care, and lack of available and accessible supports to ameliorate financial consequences. Findings illustrate the reality of financial consequences across the trajectory of young onset dementia. These consequences may manifest differently for spousal and child carers and are not being adequately addressed by existing supports.
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Affiliation(s)
- Melanie Bayly
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, 7235University of Saskatchewan, Saskatoon, Canada
| | - Megan E O'Connell
- Department of Psychology, 7235University of Saskatchewan, Saskatoon, Canada
| | - August Kortzman
- Department of Psychology, 7235University of Saskatchewan, Saskatoon, Canada
| | - Shelley Peacock
- College of Nursing, 7235University of Saskatchewan, Saskatoon, Canada
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, 7235University of Saskatchewan, Saskatoon, Canada
| | - Andrew Kirk
- College of Medicine, 7235University of Saskatchewan, Saskatoon, Canada
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Talbot CV, O'Dwyer ST, Clare L, Heaton J. The use of Twitter by people with young-onset dementia: A qualitative analysis of narratives and identity formation in the age of social media. DEMENTIA 2021; 20:2542-2557. [PMID: 33765848 PMCID: PMC8564236 DOI: 10.1177/14713012211002410] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A diagnosis of dementia in midlife can be challenging, causing losses or changes in a
person’s identity. Narrative provides a means of reconstructing identity and can be
communicated on social media. There has been initial evidence on the value of Twitter for
people with dementia, but researchers have not yet directly engaged with users’
perspectives. We employed a narrative model of identity to examine why people with
dementia use Twitter and what challenges they face. Interviews were conducted with 11
younger people with dementia and analysed thematically. Participants used Twitter to
counter a loss of identity through community membership and by regaining a sense of
purpose. They sought to redefine dementia identities by challenging stigma and campaigning
for social change. The character limit of tweets facilitated narrative through which
participants preserved their identities. These findings suggest that Twitter could be an
important source of post-diagnostic support for people with young-onset dementia. However,
there are some risks as Twitter was sometimes a hostile environment for individuals who
did not present in a ‘typical’ manner, or faced technical difficulties because of their
symptoms. In the future, platform developers could work with people with dementia to make
Twitter more accessible for this group.
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Affiliation(s)
| | | | - Linda Clare
- College of Medicine and Health, 171002University of Exeter, UK
| | - Janet Heaton
- Division of Rural Health and Wellbeing, 7709University of the Highlands and Islands, UK
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Awata S, Edahiro A, Arai T, Ikeda M, Ikeuchi T, Kawakatsu S, Konagaya Y, Miyanaga K, Ota H, Suzuki K, Tanimukai S, Utsumi K, Kakuma T. Prevalence and subtype distribution of early-onset dementia in Japan. Psychogeriatrics 2020; 20:817-823. [PMID: 32815229 DOI: 10.1111/psyg.12596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 01/28/2023]
Abstract
AIM People living with early-onset dementia (EOD) have specific social needs. Epidemiological studies are needed to obtain current information and provide appropriate service planning. This study aimed to clarify the current prevalence and subtype distribution of EOD, as well as the services frequently used by individuals with EOD. METHODS A multisite, population-based, two-step study was conducted. Questionnaires were sent to 26 416 candidate facilities in 12 areas with a target population of 11 630 322 to inquire whether any individuals with EOD had sought services or stayed during the last 12 months (step 1). When "yes" responses were received, additional questionnaires were sent to the facilities both to complete and to distribute to the target individuals with EOD to obtain more detailed information, including the dementia subtype (step 2). RESULTS In step 1, valid responses were obtained from 16 848 facilities (63.8%), and 4077 cases were identified. In step 2, detailed information was obtained for 1614 cases (39.6%) from the facilities and 530 cases (13.0%) from the individuals. The national EOD prevalence rate was estimated to be 50.9/100 000 population at risk (95% confidence interval: 43.9-57.9; age range, 18-64 years). The number of individuals with EOD was estimated to be 35 700 as of 2018. Alzheimer-type dementia (52.6%) was the most frequent subtype, followed by vascular dementia (17.1%), frontotemporal dementia (9.4%), dementia due to traumatic brain injury (4.2%), dementia with Lewy bodies/Parkinson's disease dementia (4.1%), and dementia due to alcohol-related disorders (2.8%). Individuals with EOD were most frequently identified at medical centers for dementia. CONCLUSION The prevalence rate estimated in this study was comparable to those in previous studies in Japan. However, the subtype distribution differed, with Alzheimer-type dementia being the most prominent. Based on the case identification frequencies, medical centers for dementia are expected to continue to function as the primary special health service by providing quality diagnosis and post-diagnostic support for individuals with EOD.
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Affiliation(s)
- Shuichi Awata
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tetsuaki Arai
- Department of Psychiatry, Division of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata, Japan
| | - Shinobu Kawakatsu
- Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Aizu, Japan
| | - Yoko Konagaya
- Division of Research, Obu Dementia Care and Training Center, Obu, Japan
| | | | - Hidetaka Ota
- Advanced Research Center for Geriatric and Gerontology, Akita University, Akita, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan
| | - Satoshi Tanimukai
- Department of Comprehensive Community Care for Elderly, Nursing and Health Science, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Kumiko Utsumi
- Department of Psychiatry, Sunagawa City Medical Center, Sunagawa, Japan
| | - Tatsuyuki Kakuma
- Biostatistics Center, Kurume University School of Medicine, Kurume, Japan
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O'Malley M, Parkes J, Campbell J, Stamou V, LaFontaine J, Oyebode JR, Carter J. Receiving a diagnosis of young onset dementia: Evidence-based statements to inform best practice. DEMENTIA 2020; 20:1745-1771. [PMID: 33124442 PMCID: PMC8216318 DOI: 10.1177/1471301220969269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction Better understanding of patient experience is an important driver for service improvements and can act as a lever for system change. In the United Kingdom, the patient experience is now a central issue for the National Health Service Commissioning Board, clinical commissioning groups and the providers they commission from. Traditionally, dementia care in the United Kingdom has focused predominantly on the individual experience of those with late onset dementia, while the voice of those with young onset dementia has been, comparatively, unheard. This study aims to improve the understanding of the personal experience of younger people undergoing investigation for dementia. Methods A modified Delphi approach was undertaken with 18 younger people with dementia and 18 supporters of people with young onset dementia. Questions were informed by a scoping review of the literature (O’Malley, M., Carter, J., Stamou, V., Lafontaine, J., & Parkes, J. (2019a). Receiving a diagnosis of young onset dementia: A scoping review of lived experiences. Ageing & Mental Health, 0(0), 1-12). Summary individual statements were refined over two rounds to a final list of 29 key statements. Results Twenty-seven of these statements were rated as absolutely essential or very important and included (1) for the general practitioner to identify dementia in younger people, (2) clinicians should be compassionate, empathic and respectful during the assessment and particularly sensitive when providing information about a diagnosis, and (3) remembering that receiving the diagnosis is a lot to absorb for a person with dementia and their supporter. Statistical analyses found no difference in the scoring patterns between younger people with dementia and supporters, suggesting similar shared experiences during the diagnostic process. Conclusion Understanding the uniquely personal experience of young people going through the process of diagnosis for dementia is essential to provide person-centred, needs-led, and cost-effective services. Patient’s values and experiences should be used to support and guide clinical decision-making.
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Affiliation(s)
| | - Jacqueline Parkes
- UoN Dementia Research & Innovation Centre, Faculty of Health, Education and Society, 6087University of Northampton, Northampton, UK
| | - Jackie Campbell
- Faculty of Health, Education and Society, 6087University of Northampton, Northampton, UK
| | | | | | - Jan R Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, 1905University of Bradford, Bradford, UK
| | - Janet Carter
- Faculty of Brain Sciences, Division of Psychiatry, Maple House, 4919University College London, London, UK
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Bannon S, Reichman M, Popok P, Wagner J, Gates M, Uppal S, LeFeber L, Wong B, Dickerson BC, Vranceanu AM. In It Together: A Qualitative Meta-Synthesis of Common and Unique Psychosocial Stressors and Adaptive Coping Strategies of Persons With Young-Onset Dementia and Their Caregivers. THE GERONTOLOGIST 2020; 62:e123-e139. [PMID: 33125490 DOI: 10.1093/geront/gnaa169] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The common and unique psychosocial stressors and adaptive coping strategies of people with young-onset dementia (PWDs) and their caregivers (CGs) are poorly understood. This meta-synthesis used the stress and coping framework to integrate and organize qualitative data on the common and unique psychosocial stressors and adaptive coping strategies employed by PWDs and CGs after a diagnosis of young-onset dementia (YOD). RESEARCH DESIGN AND METHODS Five electronic databases were searched for qualitative articles from inception to January 2020. Qualitative data were extracted from included articles and synthesized across articles using taxonomic analysis. RESULTS A total of 486 articles were obtained through the database and hand searches, and 322 articles were screened after the removal of duplicates. Sixty studies met eligibility criteria and are included in this meta-synthesis. Four themes emerged through meta-synthesis: 1) common psychosocial stressors experienced by both PWDs and CGs, 2) unique psychosocial stressors experienced by either PWDs or CGs, 3) common adaptive coping strategies employed by both PWDs and CGs, and 4) unique adaptive coping strategies employed by either PWDs or CGs. Within each meta-synthesis theme, subthemes pertaining to PWDs, CGs, and dyads (i.e., PWD and CG as a unit) emerged. DISCUSSION AND IMPLICATIONS The majority of stressors and adaptive coping strategies of PWDs and CGs were common, supporting the use of dyadic frameworks to understand the YOD experience. Findings directly inform the development of resiliency skills interventions to promote adaptive coping in the face of a YOD diagnosis for both PWDs and CGs.
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Affiliation(s)
- Sarah Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Paula Popok
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Juliana Wagner
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Melissa Gates
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Simrit Uppal
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lisa LeFeber
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Bonnie Wong
- Frontotemporal Disorders Unit, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Bradford C Dickerson
- Frontotemporal Disorders Unit, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ana Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Durgante H, Contreras ML, Backhouse T, Mavrodaris A, Ferreira MG, Paulo DLV, Alves MV, Serelli LDS, de Souza LC, Kishita N. Challenges in dementia care: comparing key issues from Brazil and the United Kingdom. Dement Neuropsychol 2020; 14:216-222. [PMID: 32973975 PMCID: PMC7500811 DOI: 10.1590/1980-57642020dn14-030003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The United Kingdom-Brazil Dementia Workshop took place in July 2019 in the city
of Belo Horizonte, MG, Brazil, with an interdisciplinary group of health and
care professionals from the United Kingdom and from Brazil to address challenges
in diagnosis, public perception and care of dementia. The aim of this article is
to present the results identified in relation to challenges in the care of
dementia, including recommendations that could potentially guide local and
State/Municipal authorities and care services for people with dementia in the
future. Four key issues were prioritised to identify challenges and generate
possible solutions in Brazil and the United Kingdom: I) limitations of current
health systems; II) continuous and long-term support for family carers
(pre-diagnosis, mourning); III) support for people with advanced dementia and
end-of-life care; IV) support for people with young-onset dementia. In both
countries, carers feel left without post-diagnostic support; information on the
progression of dementia is lacking and some people do not even have a specific
diagnosis; encouraging and providing training for carers best manage some of the
symptoms is imperative; preparation for end of life care and support carers
after the death of their loved ones remains highly needed; strengthening
services and qualification of health professionals, also creating protocols to
guide dementia-related services represent a common challenge to overcome. The
authors outline recommendations according to the issues identified to assist
future formulation of adequate policies and services for people with dementia
and carers.
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Affiliation(s)
- Helen Durgante
- Departamento de Psiquiatria, Universidade Federal de São Paulo - São Paulo, SP, Brazil
| | | | - Tamara Backhouse
- School of Health Sciences, University of East Anglia - Norwich, United Kingdom
| | - Angelique Mavrodaris
- Cambridge Institute of Public Health, University of Cambridge - Cambridge, United Kingdom
| | - Michele Gomes Ferreira
- Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | | | - Marcus Vinicius Alves
- Departamento de Psicobiologia, Universidade Federal de São Paulo - São Paulo, SP, Brazil
| | | | - Leonardo Cruz de Souza
- Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia - Norwich, United Kingdom
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Buggins SL, Clarke C, Wolverson E. Resilience in older people living with dementia - A narrative analysis. DEMENTIA 2020; 20:1234-1249. [PMID: 32460547 DOI: 10.1177/1471301220927614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dominant discourses surrounding dementia tend to focus on narratives of loss and decline. Simultaneously, individuals living with dementia are vulnerable to being dispossessed of personal narratives supportive of identity and well-being. How older people with dementia story their experiences of resilience in this context has not previously been investigated. In response, this qualitative study utilised a narrative approach to understand lived experiences of resilience shared by eight older people living with dementia. Structural analyses indicated that participants' personal narratives regarding resilience in living with dementia contained distinct and common phases (The Diagnosis, Initial Tasks, 'The High Point', Reflecting on Limitations and Focusing on Today) as well as a variety of dynamic characters. Overarching themes within participants' narratives included sense of self/identity, being connected to others, sense of agency and having positive attitudes. Participants narrated richer, more active personal stories than those typically represented in dominant social discourses surrounding dementia. As such, their narratives depict lived experiences of resilience that unfolded over time in response to adversity and uncertainty and involved a dialectical process in relation to adjustment and well-being. The findings have important implications for the way resilience in living with dementia is framed and supported.
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Kilty C, Boland P, Goodwin J, de Róiste Á. Caring for People With Young Onset Dementia: An Interpretative Phenomenological Analysis of Family Caregivers' Experiences. J Psychosoc Nurs Ment Health Serv 2019; 57:37-44. [PMID: 31437284 DOI: 10.3928/02793695-20190821-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/19/2019] [Indexed: 11/20/2022]
Abstract
People with young onset dementia (YOD) experience many unique challenges. Similarly, family caregivers experience changing personal, familial, and societal roles. However, YOD is under recognized and under resourced with a lack of dedicated models of care. The current study explored family members' experience of caregiving for persons with YOD to identify barriers and opportunities to accessing support. Qualitative interviews were conducted with six family caregivers, using interpretative phenomenological analysis. Findings show that caregivers experience significant uncertainty within their role, difficulty accessing timely diagnosis, and face unclear care pathways and age-related restrictions to accessing support. These findings also reflect elements of ambiguous loss and anticipatory grief: caregivers experienced sudden changes to relationships and family structure, along with the anticipation of a changed future. Optimum models of care should target timely diagnosis and clear post-diagnosis pathways and services that are flexible, relevant, and accessible. Services should offer psychosocial support for family members as they adjust to their new role as caregivers. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 37-44.].
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