Daily Living with Dementia: Two Cases

A Life-World of Altering Meaning: Expressions of the Illness Experience of Dementia in Everyday Life over 3 Years

The aim of this study was to describe the illness experiences of two participants with dementia, as expressed in their everyday lives during 3 years of disease progression. Data were collected at intervals by participant observations and conversational interviews and analyzed via a phenomenological and interpretive method. The findings describe an illness experience characterized by an altering meaning of the concretely present life-world for the participants. This was exhibited by an increasingly existential meaning of the objects and tasks of everyday life, while the perception of the life-world as taken for granted seemed to gradually decrease. Furthermore, participants experienced being threatened by a lack of order and control and uniquely responded to these experiences. Living with the changes and the threat seemed to imply insecurity and doubtful hope, diminishing social contacts, and increasing dependency, but the meaning of the consequences differed between participants. On the basis of the presented structure of the phenomena, a possible way of understanding the illness experience and its meaning in progressively dementing diseases in the occupations of everyday life was exemplified and suggested from a phenomenological point of view.

Day care for persons with dementia

Day care, as a type of care in between residential care and home help, has been available for several years, and is often referred to as an adequate alternative form of care for people with dementia. The goals of Swedish day care are to create a meaningful day for participants, offer family caregivers respite, and provide care for persons with dementia. The aim of this Swedish study was to describe day care clients with dementia problems over a 12-month period, and to discuss what distinguished those who discontinued day care from those who stayed with it. Of the clients, 76 percent were diagnosed by a doctor as having dementia between level one and four out of a total of six levels, according to the Berger rating scale of severity of senility. The results showed that one third of the people with dementia discontinued within four months. Another third dropped out within 12 months. People with behavioral problems and those who needed assistance with dressing and toileting discontinued earliest. All caregivers found some benefit of day care for their relatives and for themselves, with the exception of some caregivers of those who ended within four months. Most of the clients who lived alone at the start of day care, and ended within 12 months, went to a nursing home. Two differing conclusions may be drawn from the findings: (1) that offering day care services to persons with dementia who also show signs of behavioral problems is questionable; or (2) that the planning of day care in Sweden should be adjusted to also meet the needs of persons with behavioral problems, such as depression. In its current form, day care in Sweden seems only partially to fulfil its goals.

Managing Changes in Everyday Occupations: The Experience of Persons with Alzheimer's Disease

The aim of this study was to uncover how people with dementia respond to the problems and changes they experience in everyday occupations. Seven participants with dementia were included. Data were collected by means of repeated interviews and observations that focused on the person's experiences of competence and management in everyday occupations. The analysis was carried out from within a phenomenological perspective and resulted in a structure describing management strategies. It was concluded that the participants used a wide variety of strategies. Some strategies were directed toward managing the altered conditions caused by the disease while others served the purpose of responding to the occupational problems of everyday life. The latter strategies were of three types based mainly on environment, habituation, and cognition. Overall, the implicit and explicit cognitive awareness underpinning many strategies seems to call for great caution when assuming that people with dementia soon lose their awareness of disability.

How can we get access to the experiences of people with dementia?

This paper suggests and discusses a methodological approach that aims to facilitate the inclusion of people with dementia in research where the ambition is to better understand their experiences. People with dementia have commonly not been included as informants in research as their cognitive deficits have been regarded as a hindrance. Moreover, in the qualitative research tradition, most inquiries rely on data obtained from interviews, thereby requiring communication and verbal skills, which are skills that are affected early in the cause of dementia. Consequently, the considerably under-researched area of how dementia is experienced and managed from the perspective of those afflicted has long been put aside. This paper suggests that a combination of qualitative observations and adapted interviews may make it possible for people with dementia to participate as research informants. Issues concerned with creating a relationship with informants with dementia and helping them to elicit their experiences are elaborated and discussed. Some suggestions are made concerning how the context can be used for this intent, and how the observations and interviews can be adapted to the informants with dementia.

The use of everyday technology by people with dementia living alone: mapping out the difficulties

While the technological development available to society is taking quantum leaps, we have little knowledge of how people with mild dementia manage to cope with familiar technology at home, such as television and electronic household machines, or new technology, such as remote controls, cell phones and computers. As this technology represents a potential problem area, the aim of this qualitative, exploratory study was to identify and characterize difficulties with and hindrances to using everyday technology, as they appeared in data, for persons with early stage dementia. Eight participants with dementia were included in an extensive data collection consisting of repeated interviews and observations made in the home; the data were analyzed adopting a constant comparative approach. The results exhibit a taxonomy of difficulties in four domains, encompassing conditions that interfere with the use of the technology, deficiencies in knowledge and in the communication between users and their technology, and limitations in the use of instructions. Typically, difficulties appeared in complex combinations. They arose when familiar technology was being used, and not only when new technology was to be used. This raised concerns about the need these people have for support in home and in society. Further research is needed to validate the findings.

Reframing Person-Centered Nursing Care for Persons With Dementia

Alzheimer’s dementia manifests in a complex clinical presentation that has been addressed from both biomedical and phenomenological perspectives. Although each of these paradigmatic perspectives has contributed to advancement of the science, neither is adequate for theoretically framing a person-centered approach to nursing care. The need-driven dementia-compromised behavior (NDB) model is discussed as an exemplar of midrange nursing theory that promotes the integration of these paradigmatic views to promote a new level of excellence in person-centered dementia care. Clinical application of the NDB promotes a new level of praxis, or thoughtful action, in the care of persons with dementia.

Telephone use among noninstitutionalized persons with dementia living alone: mapping out difficulties and response strategies

The aim of this study was to map out and describe difficulties and response strategies in telephone use among elderly, noninstitutionalized persons with dementia living alone. To obtain explorative data, interviews and observations in the homes were undertaken with 10 participants diagnosed with dementia. The participants were observed when showing their telephones, calling a well-known number, responding to a request previously sent by letter to make a telephone call, and finding a number in the telephone directories. The data were analysed using a comparative approach, and resulted in descriptive categories. The participants' difficulties were categorized as difficulty in 'knowing what', 'knowing where', 'knowing how' and overcoming motor, perceptual, verbal and environmental obstacles. In responding to these, they used a variety of environmentally related strategies such as using perception or habits and habitual places, verbalizing aloud, seeking help from others, and adjusting the physical environment. They also used a few cognitively related strategies such as repeating and stopping and reflecting. Overall, difficulties were frequent and common, and the effectiveness of the strategies was questionable. The results indicate that it might be unrealistic to assume that elderly persons with symptoms of dementia who live alone are able to satisfactorily use the telephone for safety, communication and participation in society.