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Kontos P, Grigorovich A, Dupuis SL, Colobong R, Gray J, Jonas-Simpson C, Serota A. Projecting a Critique of Stigma Associated With Dementia on Screen: The Impact of a Canadian Film on the Importance of Relational Caring in the Community. THE GERONTOLOGIST 2024; 64:gnad045. [PMID: 37067944 DOI: 10.1093/geront/gnad045] [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: 09/06/2022] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Relational caring has the capacity to reduce stigma associated with dementia by shifting the focus from dysfunction and behavior management, to attending to the interdependencies and reciprocities that underpin caring relationships, and making explicit the centrality of relationships to quality care, growth, and quality of life. Education, particularly arts-based approaches, has been identified as a key strategy to decrease stigma. Yet rarely are the arts utilized in educational initiatives, and particularly so in community care settings. With an interest in redressing this, our team evaluated the impact of a Canadian filmed research-based drama-Cracked: new light on dementia-about stigma associated with people living with dementia and their families. RESEARCH DESIGN AND METHODS We conducted interviews with family carers of people living with dementia and formal care providers affiliated with community-based dementia care, and also the general public at 3 and 8 months postscreening. RESULTS Our analysis of participants' perceptions/experiences illustrates the effectiveness of Cracked in reducing stigma by demonstrating changes in the understanding of dementia and changes in practice. Our analysis also includes attention to how the film, as a form of cultural production, deepened engagement and facilitated transformation. DISCUSSION AND IMPLICATIONS Our evaluation of Cracked demonstrates that it is an effective strategy for decreasing the stigma associated with dementia by promoting relational caring. It also importantly contributes to the theoretical literature that supports film-based approaches to stigma reduction.
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Affiliation(s)
- Pia Kontos
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alisa Grigorovich
- Department of Recreation and Leisure Studies, Recreation and Leisure Studies, Brock University, St. Catharines, Ontario, Canada
| | - Sherry L Dupuis
- Department of Recreation and Leisure Studies, Recreation and Leisure Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - Romeo Colobong
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Julia Gray
- Department of Health and Society, University of Toronto-Scarborough, Scarborough, Ontario, Canada
| | | | - Alexine Serota
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Steele L, Swaffer K, Siciliano H, Rose E, Mitchell WJ, Kobier K, Bailey B. Reparations for people living with dementia: Recognition, accountability, change, now! DEMENTIA 2023; 22:1738-1756. [PMID: 37542425 DOI: 10.1177/14713012231190832] [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: 08/07/2023]
Abstract
There is a significant and longstanding problem of harm to people living with dementia in long term care institutions ('LTC institutions', referred to by others as 'care homes', 'nursing homes', 'long term care', 'residential aged care facilities'), along with a failure to redress the harm or hold people accountable for this harm. This article reports on an Australian project that found reparations must be a response to harm to people living with dementia in residential aged care. Using a disability human rights methodology, focus groups were conducted with people living with dementia, care partners and family members, advocates and lawyers to explore perspectives on why and how to redress harm to people living with dementia in Australian LTC institutions. Researchers found four key themes provide the basis for the necessity and design of a reparative approach to redress - recognition, accountability, change, now. The article calls for further attention to reparations in dementia scholarship, with a particular focus on the role that can be played in the delivery of reparations by the LTC industry, dementia practitioners, and dementia scholars. Ultimately, this article provides a new understanding of responses to violence, abuse, neglect and other harms experienced by people living with dementia in LTC institutions, which centres justice, rights, and transformative change.
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Affiliation(s)
- Linda Steele
- Faculty of Law, University of Technology Sydney, Broadway, NSW, Australia
| | - Kate Swaffer
- School of Justice and Society, University of South Australia, Adelaide, Australia
| | - Hope Siciliano
- Faculty of Law, University of Technology Sydney, Broadway, NSW, Australia
| | - Evelyn Rose
- School of Social and Political Sciences, The University of Melbourne, VIC, Australia
| | - William John Mitchell
- College of Business, Law and Governance, James Cook University, Townsville, QLD, Australia
| | - Karen Kobier
- People with Disability Australia, Sydney, NSW, Australia
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Cook C, Henrickson M, Schouten V. Palliative Care, Intimacy, and Sexual Expression in the Older Adult Residential Care Context: "Living until You Don't". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13080. [PMID: 36293660 PMCID: PMC9603265 DOI: 10.3390/ijerph192013080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/22/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Commonly, frail older adults move to residential care, a liminal space that is their home, sometimes a place of death, and a workplace. Residential facilities typically espouse person-centred values, which are variably interpreted. A critical approach to person-centred care that focuses on social citizenship begins to address issues endemic in diminishing opportunities for intimacy in the end-of-life residential context: risk-averse policies; limited education; ageism; and environments designed for staff convenience. A person-centred approach to residents' expressions of intimacy and sexuality can be supported throughout end-of-life care. The present study utilised a constructionist methodology to investigate meanings associated with intimacy in the palliative and end-of-life care context. There were 77 participants, including residents, family members and staff, from 35 residential facilities. Analysis identified four key themes: care home ethos and intimacy; everyday touch as intimacy; ephemeral intimacy; and intimacy mediated by the built environment. Residents' expressions of intimacy and sexuality are supported in facilities where clinical leaders provide a role-model for a commitment to social citizenship. Ageism, restrictive policies, care-rationing, functional care, and environmental hindrances contribute to limited intimacy and social death. Clinical leaders have a pivotal role in ensuring person-centred care through policies and practice that support residents' intimate reciprocity.
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Affiliation(s)
- Catherine Cook
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand
| | - Mark Henrickson
- School of Social Work, Massey University, Auckland 0745, New Zealand
| | - Vanessa Schouten
- School of Humanities, Media and Communication, Massey University, Palmerston North 4442, New Zealand
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O'Connor D, Sakamoto M, Seetharaman K, Chaudhury H, Phinney A. Conceptualizing citizenship in dementia: A scoping review of the literature. DEMENTIA 2022; 21:2310-2350. [PMID: 35768395 PMCID: PMC9483710 DOI: 10.1177/14713012221111014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Citizenship has provided an important conceptual framework in dementia research
and practice over the past fifteen years. To date, there has been no attempt to
synthesize the multiple perspectives that have arisen in this literature. The
purpose of this paper is to explore, reflect on, and contrast, the key concepts
and trends in the citizenship discourse as it relates to people with dementia.
Using a scoping review methodology, forty-nine articles were identified for
review. Despite the use of different descriptors, thematic analysis revealed
four core themes underpinning citizenship discourse: 1) the relationality of
citizenship; 2) facilitated agency and autonomy; 3) attention to stigma,
discrimination and exclusion; and 4) recognition of the possibilities of
identity and growth. Overall, this scoping review found a major emphasis on
expanding definitions of agency and autonomy to render citizenship unconditional
and inclusive of the diverse life experiences of people living with dementia.
Notably, there is recognition that a more intersectional lens for embedding the
subjective experience within a broader socio-political context is needed. Whilst
the adoption of a citizenship lens in dementia research and practice has had
real-world implications for policy and research, its exploration and use
continue to be led by academics, highlighting the importance that future
research involve input form people with dementia.
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Affiliation(s)
- Deborah O'Connor
- School of Social Work, 8166University of British Columbia, Vancouver, BC, Canada
| | - Mariko Sakamoto
- Centre for Research on Personhood in Dementia, 8166University of British Columbia, Vancouver, BC, Canada
| | - Kishore Seetharaman
- Department of Gerontology, 1763Simon Fraser University, Vancouver, BC, Canada
| | - Habib Chaudhury
- Department of Gerontology, 1763Simon Fraser University, Vancouver, BC, Canada
| | - Alison Phinney
- School of Nursing, 8166University of British Columbia, Vancouver, BC, Canada
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Grigorovich A, Kontos P, Heesters A, Martin LS, Gray J, Tamblyn Watts L. Dementia and sexuality in long-term care: Incompatible bedfellows? DEMENTIA 2021; 21:1077-1097. [PMID: 34904897 PMCID: PMC9189437 DOI: 10.1177/14713012211056253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the recognized benefits of sexual expression and its importance in the lives of people living with dementia, research demonstrates that there are multiple barriers to its positive expression (e.g., expression that is pleasurable and free of coercion, discrimination, and violence) in RLTC homes. These barriers constitute a form of discrimination based on age and ability, and violate the rights of persons living with dementia to dignity, autonomy, and participation in everyday life and society. Drawing on a human rights approach to dementia and sexual expression, we explored the experiences of diverse professionals, family members, and persons living with dementia with explicit attention to the ways in which macro-level dynamics are influencing the support, or lack thereof, for sexual expression at the micro level. Focus groups and in-depth interviews were conducted with 27 participants, and the collected data were analyzed thematically. While all participants acknowledged that intimacy and sexual expression of persons living with dementia should be supported, rarely is such expression supported in practice. Micro-level factors included negative attitudes of professionals toward sexual expression by persons living with dementia, their discomfort with facilitating intimacy and sexual expression in the context of their professional roles, their anxieties regarding potential negative reactions from family members, and concerns about sanctions for failing to prevent abuse. In our analysis, we importantly trace these micro-level factors to macro-level factors. The latter include the cultural stigma associated with dementia, ageism, ableism, and erotophobia, all of which are reproduced in, and reinforced by, professionals' education, as well as legal and professional standards that exclusively focus on managing and safeguarding residents from abuse. Our analysis demonstrates a complexity that has enormous potential to inform future research that is critically needed for the development of educational initiatives and to promote policy changes in this area.
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Affiliation(s)
- Alisa Grigorovich
- Department of Recreation and Leisure Studies, Brock University, St. Catharines, ON, Canada; KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Pia Kontos
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network - University Health Network, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ann Heesters
- Bioethics, University Health Network, Toronto, ON, Canada; Education Investigator 2, TIER (The Institute for Education Research), University Health Network, Toronto, ON, Canada; Assistant Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Joint Centre for Bioethics, University of Toronto, ON, Canada
| | | | - Julia Gray
- Department of Health & Society, University of Toronto Scarborough, Scarborough, ON, Canada
| | - Laura Tamblyn Watts
- CanAge, Canada's National Seniors' Advocacy Organization, Toronto, ON, Canada
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Sandberg LJ, Rosqvist HB, Grigorovich A. Regulating, fostering and preserving: the production of sexual normates through cognitive ableism and cognitive othering. CULTURE, HEALTH & SEXUALITY 2021; 23:1421-1434. [PMID: 32772835 DOI: 10.1080/13691058.2020.1787519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
People with cognitive disabilities are commonly positioned as risky sexual subjects. This article discusses the discursive production of sexual normates in the form of desirable and normative able-minded sexual subjects, in scientific research on the sexuality and cognitive disabilities of younger and older individuals (in particular those with dementia). We identify three interrelated discourses: regulating sexuality; fostering sexuality; and preserving sexuality. The first of these, regulation, pathologises sexuality of people with cognitive disabilities as faulty and in need of restriction. The second discourse, fostering, is more affirmative and argues for educating for a 'healthy' sexuality of people with cognitive disabilities, to mitigate risks of abuse. This discourse is more salient with younger people. The third discourse, preservation, in contrast, is more visible with older people with dementia and affirms sexuality so long as it is consistent with a 'genuine' or 'authentic' sexuality of the past. In conclusion, scientific research reinforces the cultural ideal of the rational and autonomous individual (and as such the mature/adult) capable of making independent decisions and engaging in healthy, good sex, based on stable sexual identities. Findings demonstrate how age intersects with cognitive ableism to intensify the cultural anxiety that exists around the sexualities of people with cognitive disabilities.
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Affiliation(s)
- Linn J Sandberg
- School of Culture and Education, Södertörn University, Huddinge, Sweden
| | | | - Alisa Grigorovich
- The Kite Research Institute-UHN, University of Toronto, Toronto, Canada
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Peisah C, Ayalon L, Verbeek H, Benbow SM, Wiskerke E, Rabheru K, Sorinmade O. Sexuality and the Human Rights of Persons With Dementia. Am J Geriatr Psychiatry 2021; 29:1021-1026. [PMID: 34183238 DOI: 10.1016/j.jagp.2021.05.016] [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: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
We explore barriers to enjoyment of human rights to sexuality of persons with dementia and remedies for addressing these. Enjoyment of sexuality is contingent upon actualization of rights to dignity, autonomy, respect for will and preferences, abuse safeguarding and equitable access to highest standards of sexual health. Persons with dementia living at home or in care face systemic barriers to enjoyment of sexuality fueled by ageism, apathy and ignorance, compounded by complex legal barriers in relation to consent. Such challenges can be tackled with awareness raising and education of care staff, families and physicians, including training for capacity assessment with dimensional, noncategorical conceptualization of capacity, leaving room for supported decision-making. These measures, together with strengthened legislative and human rights frameworks to cater to the specific needs of older people, may allow people to live well with dementia and exercise their human rights to enjoy sexuality in a safe and lawful manner.
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Affiliation(s)
- Carmelle Peisah
- School of Psychiatry, Faculty Medicine & Ageing Futures Institute, University of New South Wales, Capacity Australia (CP), Sydney, Australia.
| | - Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University (LA), Ramat Gan, Israel
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University (HV), Maastricht, the Netherlands
| | - Susan Mary Benbow
- Centre for Ageing & Mental Health, University of Chester (SMB), Chester, United Kingdom
| | | | - Kiran Rabheru
- University of University of Ottawa (KR), Ottawa, Ontario, Canada
| | - Oluwatoyin Sorinmade
- Old Age Psychiatry, Kent and Medway NHS and Social Care Partnership Trust (OS), Kent, UK
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8
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Jonas-Simpson C, Mitchell G, Dupuis S, Donovan L, Kontos P. Free to be: Experiences of arts-based relational caring in a community living and thriving with dementia. DEMENTIA 2021; 21:61-76. [PMID: 34166151 PMCID: PMC8739588 DOI: 10.1177/14713012211027016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To present findings about experiences of relational caring at an arts-based academy for persons living with dementia. BACKGROUND There is a compelling call and need for connection and relationships in communities living with dementia. This study shares what is possible when a creative arts-based academy for persons living with dementia grounded in relational inquiry and caring focuses on relationships through the medium of the arts. DESIGN A qualitative phenomenological methodology (informed by van Manen) was used to answer the research question, "What is it like to experience relational caring at an arts-based academy for persons living with dementia?" We address two research objectives: (1) to explore how relationships are experienced when a relational caring philosophy underpins practice, including arts-based engagements; and (2) to understand the meaning of relationships that bring quality to day-to-day living. METHODS Twenty-five participants were recruited from the Academy and interviewed in one-to-one in-depth interviews or small groups. Participants included five persons living with dementia, eight family members, four staff, five artists, one personal support worker, and two volunteers. Participants were asked to describe their experiences of relational caring or relationships in the Academy space. FINDINGS Three thematic patterns emerged, which address the research objectives.Relational caring is experienced when:freedom and fluid engagement inspire a connected spontaneous liveliness;embracing difference invites discovery and generous inclusivity; andmutual affection brings forth trust and genuine expression. CONCLUSIONS Findings contribute to the growing body of knowledge about both relational caring and arts-based practices that call forth a different ethic of care-one that is relational, inclusive, and intentional. Findings also shed light on what is possible when a relational caring philosophy underpins arts-based practices-everyone thrives.
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Affiliation(s)
| | | | | | - Lesley Donovan
- St. Michael's Hospital, 508783Unity Health Toronto, Toronto, ON, Canada
| | - Pia Kontos
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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9
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Schouten V, Henrickson M, Cook CM, McDonald S, Atefi N. Intimacy for older adults in long-term care: a need, a right, a privilege-or a kind of care? JOURNAL OF MEDICAL ETHICS 2021; 48:medethics-2020-107171. [PMID: 34162736 DOI: 10.1136/medethics-2020-107171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND To investigate attitudes of staff, residents and family members in long-term care towards sex and intimacy among older adults, specifically the extent to which they conceptualise sex and intimacy as a need, a right, a privilege or as a component of overall well-being. METHODS The present study was a part of a two-arm mixed-methods cross-sectional study using a concurrent triangulation design. A validated survey tool was developed; 433 staff surveys were collected from 35 facilities across the country. Interviews were conducted with 75 staff, residents and family members. RESULTS It was common for staff, residents and family members to talk about intimacy and sexuality in terms of rights and needs. As well as using the language of needs and rights, it was common for participants to use terms related to well-being, such as fun, happiness or being miserable. One participant in particular (a staff member) described receiving intimate touch as a 'kind of care'-a particularly useful way of framing the conversation. CONCLUSION While staff, residents and family frequently used the familiar language of needs and rights to discuss access to intimate touch, they also used the language of well-being and care. Reframing the conversation in this way serves a useful purpose: it shifts the focus from simply meeting minimum obligations to a salutogenic approach-one that focuses on caring for the whole person in order to improve overall well-being and quality of life.
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Affiliation(s)
- Vanessa Schouten
- School of Humanities, Media and Communication, Massey University, Palmerston North, New Zealand
| | - Mark Henrickson
- School of Social Work, Massey University-Albany Campus, Auckland, New Zealand
| | - Catherine M Cook
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | - Nilo Atefi
- School of Social Work, Massey University-Albany Campus, Auckland, New Zealand
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Henrickson M, Cook CM, MacDonald S, Atefi N, Schouten V. Not in the Brochure: Porneia and Residential Aged Care. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2021; 19:588-598. [PMID: 33815627 PMCID: PMC8010488 DOI: 10.1007/s13178-021-00573-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Sexuality and intimacy in residential aged care (RAC) are receiving increased research attention. In this article, porneia refers to access to sex workers, as well as online pornography, and masturbation by residents in RAC. Sex work is legal and regulated in Aotearoa New Zealand. METHODS The present study was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. A validated survey tool was developed. Data were collected in 2018-2019: 433 staff surveys were collected from 35 RAC across the country; 61 interviews were carried out with 77 staff, residents, and family members. RESULTS Staff opinions about sex work and pornography were inconclusive. Nevertheless, access to sex workers occurs in many RAC facilities across the country. Interviews demonstrated a diversity of responses among the three groups; staff attitudes are paramount. CONCLUSIONS Some staff are prepared for resident requests for sex workers; others continue to look to policies and management for guidance, but such policies are often lacking. Most staff have adopted the language of needs vs. rights which dominates the literature. POLICY IMPLICATIONS Staff education on sexuality and facility policy is essential; education for residents and their families is also desirable. Facilities often over-notify third parties. Discourse about sexuality needs to move towards a person-centred, salutogenic approach.
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Affiliation(s)
- Mark Henrickson
- School of Social Work, Massey University, Private Bag 102904, North Shore MSC, Auckland, 0745 New Zealand
| | - Catherine M Cook
- School of Clinical Sciences, Nursing Department, AUT University, Auckland, New Zealand
| | - Sandra MacDonald
- School of Nursing, Manukau Institute of Technology, Auckland, New Zealand
| | - Narges Atefi
- School of Social Work, Massey University, Auckland, New Zealand
| | - Vanessa Schouten
- School of Humanities, Massey University, Palmerston North, New Zealand
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Motta-Ochoa R, Incio Serra N, Frantz A, Blain-Moraes S. Enacting agency: movement, dementia, and interaction. Arts Health 2021; 14:133-148. [PMID: 33651673 DOI: 10.1080/17533015.2021.1894464] [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: 10/22/2022]
Abstract
Background: Arts-based programs can counter the dominant narrative of loss associated with dementia, in part through fostering expressions of agency. This study uses social science theories of interaction between structure and agency to examine how an arts-based movement program, entitled Mouvement de passage, supports agency among individuals with dementia. Methods: Ethnographic methods were used to trace how participants enact agency within the structure of the movement program. The program's sessions were video recorded and iteratively analyzed. Results: Participants expressed their agency in three ways: 1) transforming the exercise's structure according to individual interests and desires; 2) resisting the exercise's structure; and 3) improvising movements collectively. Conclusions: The movements of individuals with dementia were shaped by both program structure and individual/collective expressions of agency. The design of Mouvement de passage, based on open-ended structures and voluntary participation, provides a template for developing interventions that foster agency among these persons.
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Affiliation(s)
- Rossio Motta-Ochoa
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec.,Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital, Montreal, Quebec
| | - Natalia Incio Serra
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec.,Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital, Montreal, Quebec
| | - Allison Frantz
- Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital, Montreal, Quebec.,Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital Integrated Program in Neuroscience, McGill University, Montreal, Quebec
| | - Stefanie Blain-Moraes
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec.,Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital, Montreal, Quebec
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12
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Lea E, Synnes O. An intimate connection: Exploring the visual art experiences of persons with dementia. DEMENTIA 2020; 20:848-866. [PMID: 32192375 DOI: 10.1177/1471301220911264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to describe and discuss the art experience of persons with dementia taking part in guided museum tours at a Norwegian art museum. The analysis is based on semi-structured open-ended interviews with participants and researcher field notes. The results demonstrate the capacity and willingness of persons with dementia to reach out and connect on a personal level with the artworks. We identified four experiential dimensions: (1) a new way of seeing, (2) being lifted out of everyday life, (3) activating emotional and bodily responses and (4) connecting art and life. Our findings draw attention to the existential dimensions of the art experience and show that dementia-friendly programmes can offer individuals with dementia a way to stay connected both to themselves and to the wider community through active participation in a cultural discourse. This is the first research study conducted in this emerging field in a Norwegian context.
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Affiliation(s)
- Eli Lea
- Centre for Diaconia and Professional Practice, VID Specialized University, Bergen, Norway
| | - Oddgeir Synnes
- Centre for Diaconia and Professional Practice, VID Specialized University, Bergen, Norway
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Sexual Expression in Alberta's Continuing Care Homes: Capacity, Consent, and Co-decision-making. Can J Aging 2020; 40:156-165. [PMID: 31973789 DOI: 10.1017/s0714980819000813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In this article, we explore the role of substitute decision-makers (SDMs) in matters of sexual expression for continuing care residents with diminished cognitive capacity. We examine how Alberta's current use of SDMs can enable an "all-or-none" approach to competence, wherein a person either has capacity to make all decisions or is incapable of making any. Three factors facilitate an environment in which this approach can influence residents' sexual expression. These include the wording of current legislation, lack of resources for SDMs, and relational dynamics between SDMs and care staff. We provide a critical review of existing legislation and empirical evidence of its challenges in practice. Though we focus on the Alberta context, there is reason to believe that similar issues persist in other Western jurisdictions. We offer several recommendations for how we can better support residents' sexual autonomy in continuing care and avoid pitfalls of the "all-or-none" approach to competence.
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14
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Citizenship and authenticity in dementia: A scoping review. Maturitas 2019; 125:11-16. [DOI: 10.1016/j.maturitas.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 11/18/2022]
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15
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Grigorovich A, Kontos P. A critical realist exploration of the vulnerability of staff to sexual harassment in residential long-term care. Soc Sci Med 2019; 238:112356. [PMID: 31204030 DOI: 10.1016/j.socscimed.2019.112356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022]
Abstract
Despite that sexual harassment of care staff negatively affects mental health and occupational outcomes, limited research has explored this in the context of residential long-term care homes. This ethnographic study explored how female care staff (e.g. providers, supervisors) understood and responded to sexual harassment from residents within the regulatory context of residential long-term care in Ontario, Canada. Data were collected from March 2017 to March 2018 and included observations and interviews with 26 staff, as well as legal, educational, and other regulatory documents. Management strategies were found to be ineffective, and despite staff acknowledgement of the negative impact of sexual harassment, they expressed tolerance of their persistent vulnerability. Drawing on critical realism, our analysis demonstrates a complex interrelationship between staff's reflexive deliberations about their experiences, health and safety regulations, and normative assumptions underpinning the education and training that they receive. Understanding the vulnerability of staff to sexual harassment at the intersection of regulation and reflexivity has important implications for the development of an effective multi-faceted approach to prevention.
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Affiliation(s)
| | - Pia Kontos
- Toronto Rehab Institute-University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Grigorovich A, Kontos P, Kontos AP. The "Violent Resident": A Critical Exploration of the Ethics of Resident-to-Resident Aggression. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:173-183. [PMID: 30741393 DOI: 10.1007/s11673-019-09898-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
Resident-to-resident aggression is quite prevalent in long-term care settings. Within popular and empirical accounts, this form of aggression is most commonly attributed to the actions of an aberrant individual living with dementia characterized as the "violent resident." It is often a medical diagnosis of dementia that is highlighted as the ultimate cause of aggression. This neglects the fact that acts of aggression are influenced by broader structural conditions. This has ethical implications in that the emphasis on individual aberration informs public policy strategies for prevention with a focus on restricting the freedom of individuals using behavioural modification, drugs, or other restraints with the intent to protect others from harm. A more ethical approach requires attention to the structural conditions of long-term care that both foster aggression and constrain prevention efforts. To this end, we turn to a model of relational citizenship that offers a theory of embodied selfhood and relationality as essential to human dignity, thus entailing human rights protections. The application of an ethic based on this model offers a more holistic prevention strategy for resident-to-resident aggression by drawing attention to the critical need and obligation to promote human flourishing through system level efforts.
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Affiliation(s)
- Alisa Grigorovich
- Toronto Rehabilitation Institute-University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada.
| | - Pia Kontos
- Toronto Rehabilitation Institute-University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alexis P Kontos
- Department of Justice Canada, 284 Wellington Street, Ottawa, ON, K1A 0H8, Canada
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Problematizing Sexual Harassment in Residential Long-Term Care: The Need for a More Ethical Prevention Strategy. Can J Aging 2019; 39:117-127. [PMID: 30992088 DOI: 10.1017/s0714980819000199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
La promotion des droits sexuels dans les établissements de soins de longue durée est complexe sur le plan éthique, étant donné que ce milieu est à la fois une résidence et un lieu de travail. Bien que les données empiriques démontrent que le bien-être des soignants professionnels et des résidents sont inextricablement liés, les politiques publiques au Canada ne reconnaissent généralement pas cette relation et continuent de se concentrer isolément sur le bien-être des résidents ou des travailleurs. Les conséquences problématiques de cette situation sont particulièrement mises en évidence lorsque l'on considère les défis associés à la prévention du harcèlement sexuel envers les travailleurs, dans un contexte où l'on ne veut pas restreindre indûment la liberté d'expression sexuelle des résidents atteints de démence. Nous avons utilisé l'approche « Quel est le problème représenté ? » ("What's the Problem Represented to be?") de Carol Bacchi pour analyser de façon critique un plan d'action canadien récent visant à prévenir la violence et le harcèlement sexuels. Notre analyse suggère que cette approche de prévention du harcèlement sexuel n'est pas une politique publique prometteuse et pourrait même contribuer à augmenter le phénomène qu'elle vise à corriger. Il est donc urgent de concentrer les efforts de prévention sur les facteurs structurels de ce phénomène afin de soutenir les droits sexuels des soignants et des résidents. Supporting sexual rights in residential long-term care is ethically complex. The well-being of care workers and residents is inextricably linked, and increasingly recognized empirically, yet public policy in Canada generally continues to exclusively focus on either the well-being of residents or workers. The consequences of this are particularly evident when we consider how to prevent sexual harassment towards workers without unjustly restricting the freedom of sexual expression for residents living with dementia. Employing Carol Bacchi’s “What’s the Problem Represented to be?” approach, we critically analysed a recent Canadian action plan to prevent sexual violence and harassment. Our analysis suggests that this policy is less than promising and may reproduce the very phenomenon it is intended to redress. The need to refocus prevention efforts on the structural factors implicated in this phenomenon is urgent if we are to support the sexual rights of both care workers and residents.
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Grigorovich A, Kontos P. Advancing an Ethic of Embodied Relational Sexuality to Guide Decision-Making in Dementia Care. THE GERONTOLOGIST 2018; 58:219-225. [PMID: 27927731 DOI: 10.1093/geront/gnw137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/21/2016] [Indexed: 01/16/2023] Open
Abstract
Sexuality and intimacy are universal needs that transcend age, cognitive decline, and disability; sexuality is a fundamental aspect of the human experience. However, supporting sexuality in long-term residential care presents ethical challenges as this setting is both a home environment for residents and a workplace for health practitioners. This is particularly complex in the case of residents with dementia given the need to balance protection from harm and freedom of self-determination. Despite such complexity, this challenge has received limited critical theoretical attention. The dominant approach advocated to guide ethical reasoning is the bioethical four principles approach. However, the application of this approach in the context of dementia and long-term care may set the bar for practitioners' interference excessively high, restricting assentual (i.e., voluntary) sexual expression. Furthermore, it privileges cognitive and impartial decision-making, while disregarding performative, embodied, and relational aspects of ethical reasoning. With an interest in addressing these limitations, we explicate an alternative ethic of embodied relational sexuality that is grounded in a model of citizenship that recognizes relationality and the agential status of embodied self-expression. This alternative ethic broadens ethical reasoning from the exclusive duty to protect individuals from harm associated with sexual expression, to the duty to also uphold and support their rights to experience the benefits of sexual expression (e.g., pleasure, intimacy). As such it has the potential to inform the development of policies, organizational guidelines, and professional curricula to support the sexuality of persons with dementia, and thereby ensure more humane practices in long-term residential care settings.
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Affiliation(s)
- Alisa Grigorovich
- Toronto Rehabilitation Institute-University Health Network, Ontario, Canada
| | - Pia Kontos
- Toronto Rehabilitation Institute-University Health Network, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Thys K, Mahieu L, Cavolo A, Hensen C, Dierckx de Casterlé B, Gastmans C. Nurses' experiences and reactions towards intimacy and sexuality expressions by nursing home residents: A qualitative study. J Clin Nurs 2018; 28:836-849. [PMID: 30256475 DOI: 10.1111/jocn.14680] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/27/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To better understand how nurses experience and react to intimate and sexual expressions of nursing home residents. BACKGROUND Although many nursing home residents continue to desire intimacy and sexual expression, they commonly perceive negative attitudes of nursing staff towards them as a major barrier to their sexual well-being. To eliminate this barrier, it is crucial to gain a more in-depth understanding of nurses' personal experiences and reactions towards intimacy and sexuality in aged care. DESIGN Our study used a qualitative design, rooted in grounded theory. METHODS Semi-structured interviews with 15 nurses between 34 and 59 years of age were conducted. Participating nurses were recruited from seven different nursing homes in Flanders, Belgium. We used the Qualitative Analysis Guide of Leuven (QUAGOL) for data analysis. We followed the COREQ guidelines to ensure rigour in our study. RESULTS Nurses experienced and dealt with intimate and sexual expressions of residents in an individual way, which was focused on setting and respecting their own sexual boundaries and those of residents and family members. Depending on their comfort level with residents' expressions, nurses responded in three ways: active facilitation, tolerance and termination. Nurses' responses depended on contextual factors, including their personal experiences with sexuality, the nature of their relationship with the residents involved, the presence of dementia and the organisational culture of the facility. CONCLUSIONS Nurses face a wide range of experiences and emotions when confronted with residents' expressions of sexuality and intimacy. A supportive approach is needed to guide nurses in dealing with these highly sensitive situations. This approach can be promoted at the institutional level through continuous educational programmes. RELEVANCE TO CLINICAL PRACTICE This study advocates a contextual and interpretative ethical approach to sexuality in older adults, taking as starting point nurses' own vulnerability and that of residents and relatives.
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Affiliation(s)
- Kristof Thys
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Lieslot Mahieu
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Alice Cavolo
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Carolien Hensen
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | | | - Chris Gastmans
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
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Kontos P, Grigorovich A, Dupuis S, Jonas-Simpson C, Mitchell G, Gray J. Raising the curtain on stigma associated with dementia: fostering a new cultural imaginary for a more inclusive society. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1508822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Pia Kontos
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alisa Grigorovich
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sherry Dupuis
- Department of Recreation & Leisure Studies, University of Waterloo, Waterloo, Canada
- Partnerships in Dementia Care Alliance, University of Waterloo, Waterloo, Canada
| | - Christine Jonas-Simpson
- School of Nursing, York University, Toronto, Canada
- Dotsa Bitove Wellness Academy, Toronto, Canada
| | | | - Julia Gray
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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Villar F, Serrat R, Celdrán M, Fabà J, Martínez MT. Disclosing a LGB Sexual Identity When Living in an Elderly Long-Term Care Facility: Common and Best Practices. JOURNAL OF HOMOSEXUALITY 2018; 66:970-988. [PMID: 29927737 DOI: 10.1080/00918369.2018.1486062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study aims at exploring staff perceptions of common and best practices toward a situation in which an older resident discloses their non-heterosexual sexual identity, differentiating between gay men, lesbians, and bisexuals. A total of 2,254 staff members from 96 Spanish long-term care facilities took part in the study. They were asked about what they think most of their workmates would do and what they think should be done in a situation in which an older resident discloses his/her non-heterosexual sexual orientation. The results indicate that, in general, staff's attitudes to non-heterosexual older residents' disclosure of their sexual identity are quite tolerant and open. However, differences in staff perceptions of common and best practices indicate that there is still potential for improvement. Results underline that factors such as residents' sexual identity (and particularly, bisexuality), generation, professional position, and the prevailing model of care influence staff responses.
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Affiliation(s)
- Feliciano Villar
- a Department of Developmental and Educational Psychology , University of Barcelona , Barcelona , Spain
| | - Rodrigo Serrat
- a Department of Developmental and Educational Psychology , University of Barcelona , Barcelona , Spain
| | - Montserrat Celdrán
- a Department of Developmental and Educational Psychology , University of Barcelona , Barcelona , Spain
| | - Josep Fabà
- a Department of Developmental and Educational Psychology , University of Barcelona , Barcelona , Spain
| | - M Teresa Martínez
- b Social Services and Rights Department , Principado de Asturias , Oviedo , Spain
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Abstract
With the biomedicalisation and the pharmaceuticalisation of dementia, music programs, as with other arts- and leisure-based programs, have primarily been implemented as non-pharmacological means to generate social and behavioural changes. We argue that understanding and fully supporting the musicality of persons living with dementia requires engagement with citizenship discourse. Specifically we draw on a model of relational citizenship that recognizes that corporeality is a fundamental source of self-expression, interdependence, and reciprocal engagement. We articulate this argument with reference to the musicality of two residents living with dementia in long-term residential care; one example is drawn from an ethnographic study of selfhood in dementia and the other is from a study of elder-clowning. Relational citizenship brings a new and critical dimension to the discourse on music, ageing, and the body in contemporary society. It further highlights the ethical imperative to fully support musicality through institutional policies, structures and practices.
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Affiliation(s)
- Pia Kontos
- Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Alisa Grigorovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Villar F, Celdrán M, Serrat R, Fabà J, Martínez T. Staff's reactions towards partnered sexual expressions involving people with dementia living in long-term care facilities. J Adv Nurs 2018; 74:1189-1198. [PMID: 29285784 DOI: 10.1111/jan.13518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/30/2022]
Abstract
AIMS To explore staff responses, in terms of common practices, towards partnered sexual relationships in long-term care facilities where one or both people involved have dementia. It also tries to determine personal and institutional factors influencing these responses. BACKGROUND Although some studies, mostly qualitative, have focused on reactions to residents' sexual expressions so far the issue has not been assessed in a study using large and diverse samples. DESIGN Cross-sectional quantitative study using vignette technique. METHODS Participants were 2,295 staff members at 152 Spanish long-term care facilities. Data were collected during 2016. A vignette describing sexual situations involving people with dementia was presented to participants. After the vignette, participants had to answer the question: "What do you think most of your colleagues would do in this situation?" with nine possible responses. RESULTS Results showed that relationships involving persons with dementia were perceived as potentially problematic by staff. In both conditions, discussing the case with a colleague or supervisor was the most frequently chosen reaction. More restrictive reactions were mentioned when only one person with dementia was involved in the relationship. Factors such as participants" age and years of experience, professional post and commitment to person-centred care practices were related with the frequency of common restriction practices. CONCLUSION Results highlight the importance of providing staff with clear guidelines regarding the management of specific sexual situations to avoid stereotyped restrictive reactions.
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Affiliation(s)
- Feliciano Villar
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Montserrat Celdrán
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Rodrigo Serrat
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Josep Fabà
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Teresa Martínez
- Social Services and Rights Department, Principado de Asturias, Oviedo, Spain
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Cook C, Schouten V, Henrickson M, McDonald S. Ethics, intimacy and sexuality in aged care. J Adv Nurs 2017; 73:3017-3027. [DOI: 10.1111/jan.13361] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Catherine Cook
- School of Nursing; College of Health; Massey University Albany; Auckland New Zealand
| | - Vanessa Schouten
- School of Humanities; Massey University Albany; Auckland New Zealand
| | - Mark Henrickson
- School of Social Work; Massey University Albany; Auckland New Zealand
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Abstract
Behaviours such as hitting, spitting, swearing and kicking can be a common response to personal, social and environmental challenges experienced by people with dementia. Little attention, however, has been given to how partners in care experience and respond to these behaviours in the home. This paper examines the emerging theme of 'aggression,' in seven interviews with nine former partners in care of people with dementia in Ontario, Canada. We explore how partners in care talk about, interpret and respond to these behaviours drawing on recent conceptualizations of structural and interpersonal violence in health and social geography and contributing to the growing body of research on relational care. We discuss the responses to, and implications of, these behaviours at a range of spatial scales and identify important considerations for future research.
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Affiliation(s)
- Rachel V Herron
- Department of Geography, Brandon University, Brandon, Canada
| | - Mark W Rosenberg
- Department of Geography and Planning, Queen's University, Kingston, Canada
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Kontos P, Miller KL, Kontos AP. Relational citizenship: supporting embodied selfhood and relationality in dementia care. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:182-198. [PMID: 28177149 DOI: 10.1111/1467-9566.12453] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We draw on findings from a mixed-method study of specialised red-nosed elder-clowns in a long-term care facility to advance a model of 'relational citizenship' for individuals with dementia. Relational citizenship foregrounds the reciprocal nature of engagement and the centrality of capacities, senses, and experiences of bodies to the exercise of human agency and interconnectedness. We critically examine elder-clown strategies and techniques to illustrate how relational citizenship can be supported and undermined at the micro level of direct care through a focus on embodied expressions of creativity and sexuality. We identify links between aesthetic enrichment and relational practices in art, music and imagination. Relational citizenship offers an important rethinking of notions of selfhood, entitlement, and reciprocity that are central to a sociology of dementia, and it also provides new ethical grounds to explore how residents' creative and sexual expression can be cultivated in the context of long-term care.
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Affiliation(s)
- Pia Kontos
- Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Karen-Lee Miller
- Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Alexis P Kontos
- Human Rights Law Section, Department of Justice Canada, Canada
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Hwang AS, Rosenberg L, Kontos P, Cameron JI, Mihailidis A, Nygård L. Sustaining care for a parent with dementia: an indefinite and intertwined process. Int J Qual Stud Health Well-being 2017; 12:1389578. [PMID: 29050539 PMCID: PMC5654011 DOI: 10.1080/17482631.2017.1389578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/12/2022] Open
Abstract
This study aimed to understand how adult children sustain caring for persons with dementia (PwDs) within their family and formal care contexts in Canada. Half-day focus groups were conducted with adult daughters and adult sons in Toronto, Canada. Using constructivist grounded theory, we examined both substantive concepts and group dynamics. Sustaining care was interpreted as an indefinite process with three intertwined themes: reproducing care demands and dependency, enacting and affirming values, and "flying blind" in how and how long to sustain caring (i.e., responding to immediate needs with limited foresight). Family values and relationships, mistrust toward the institutional and home care systems, and obscured care foresight influenced care decisions and challenged participants in balancing their parents' needs with their own. Positive and negative aspects of care were found to influence one another. The implications of these findings for research and policy are discussed.
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Affiliation(s)
- Amy S. Hwang
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Lena Rosenberg
- Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Pia Kontos
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Jill I. Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alex Mihailidis
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Louise Nygård
- Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
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