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Living with dementia from the perspective of older people: is it a positive story?
- Author:
- STEEMAN Els
- Journal article citation:
- Aging and Mental Health, 11(2), March 2007, pp.119-130.
- Publisher:
- Taylor and Francis
Dementia, even at an early stage, may pose problems and challenge one's quality of life. Having accurate knowledge of what one experiences when living with dementia is important for developing proactive care for individuals with dementia and their families. The aim of this Grounded Theory study was to explore what it means for elderly people to live with early-stage dementia. This study interviewed 20 elderly people with probable mild dementia and their family members drawn from five memory clinics in Flanders, Belgium. Living with dementia was often presented as a positive narrative, one that told of only minor problems and which stressed abilities and contentment with life. Being valued, rather than losing one's cognition or identity was central in their experience. More in-depth analyses of participants' narratives revealed, however, that they were constantly balancing their feelings of value and worthlessness, struggling to remain someone of value. This struggle was prompted by threats posed by dementia and by the persons' interactions with others. Superficially, a positive narrative may be understood as a lack of awareness or as denial due to cognitive loss. The findings suggest, however, that we should look beyond this superficial view and seek to understand the narrative as an expression of one's attempt to counterbalance devaluation.
Meaning in Life and depressive symptoms: a person-oriented approach in residential and community-dwelling older adults
- Authors:
- VAN DER HEYDEN Karen, DEZUTTER Jessie, BEYERS Wim
- Journal article citation:
- Aging and Mental Health, 19(12), 2015, pp.1063-1070.
- Publisher:
- Taylor and Francis
In current society, an increasing population of older adults and a high prevalence of depressive symptoms in late life is noticeable. A possible protective resource is ‘Meaning in Life’. The objective of this study is to identify from a person-oriented view (a) Meaning in Life-profiles, based on Presence of Meaning and Search for Meaning dimensions, and (b) their associations with depressive symptoms. (Edited publisher abstract)
Factors determining the balance between the wish to die and the wish to live in older adults
- Authors:
- BONNEWYN Anke, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(6), 2017, pp.685-691.
- Publisher:
- Wiley
Background: The “Internal Struggle Hypothesis” (Kovacs and Beck, 1977) suggests that suicidal persons may have both a wish to live (WTL) and a wish to die (WTD). The current study investigates whether the three-group typology – “WTL”, “ambivalent (AMB)”, and “WTD” – is determined by common correlates of suicidality and whether these groups can be ordinally ranked. Methods: The sample comprised 113 older inpatients. Discriminant analysis was used to create two functions (combining social, psychiatric, psychological, and somatic variables) to predict the assignment of older inpatients into the groups WTL, AMB, and WTD. Results: The functions “Subjective Well-being” and “Social Support” allowed us to assign patients into these three distinct groups with good accuracy (66.1%). “Subjective Well-being” contrasted the groups WTD and WTL and “Social Support” discriminated between the groups WTD and AMB. “Social Support” was highest in the AMB group. Conclusions: The results suggest a simultaneous presence of a WTL and a WTD in older inpatients, and also that the balance between them is determined by “Subjective Well-being” and “Social Support”. Unexpectedly, the AMB group showed the highest scores on “Social Support”. The authors hypothesise that higher social support might function as an important determinant of a remaining WTL when a WTD is present because of a lower sense of well-being. The study suggests that the groups WTL–AMB–WTD can not situated on a one-dimensional continuum. (Edited publisher abstract)
Enabling meaningful activities and quality of life in long-term care facilities: the stepwise development of a participatory client-centred approach in Flanders
- Authors:
- DE VRIENDT Patricia, et al
- Journal article citation:
- British Journal of Occupational Therapy, 82(1), 2019, pp.15-26.
- Publisher:
- Sage
Introduction: Meaningful activities of daily living promote the quality of life of residents of long-term care facilities. This project aimed to develop an approach to enable meaningful activities of daily living and to guide long-term care facilities in a creative and innovative attitude towards residents' meaningful activities of daily living. Method: The approach was developed in six steps: (1) in-depth-interviews with 14 residents; (2) a survey with 171 residents; (3) a systematic map and synthesis review on interventions enriching meaningful activities of daily living; (4) qualitative analysis of 24 ‘good examples’ and, to support future implementation, (5) focus groups with staff (n = 69). Results determined the components of the new approach which was (6) pilot-tested in one long-term care facility. Quantitative and qualitative data were gathered concerning benefits for the residents and feasibility for the staff. Results: A client- and activity-oriented approach was developed, characterised by an active participatory attitude of residents and staff and a systematic iterative process. Significant positive effects were found for the number of activities, the satisfaction with the leisure offered, the social network, medication use, but not for quality of life. The approach appeared to be feasible. Conclusion: This approach stimulates residents' meaningful activities of daily living and social life. Further investigation is needed to evaluate its outcome and implementation potentials.
Cognitive functioning and quality of life: Diverging views of older adults with Alzheimer and professional care staff
- Authors:
- DEWITTE Laura, VANDENBULCKE Mathieu, DEZUTTER Jessie
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(8), 2018, pp.1074-1081.
- Publisher:
- Wiley
Objective: Staff ratings of quality of life (QOL) in dementia are often lower and more strongly related to the cognitive functioning of the person with dementia than self‐ratings. However, cognition‐related items in QOL measures and limited cognitive screening measures hamper a clear understanding of the relationship, two issues addressed in the current study. Methods: The authors collected data of 88 pairs of older adults with Alzheimer disease and their professional caregivers in 9 residential care settings. Both self‐report and staff report of the QOL of residents were assessed with the Quality of Life in Alzheimer's Disease. Cognitive functioning was assessed with the Mini‐Mental State Examination and a battery of specific cognitive measures. Results: Intraclass correlations and a paired sample t test confirmed a discrepancy between self‐rating and staff rating, with staff significantly underestimating QOL as experienced by the resident. After removing the possibly confounding memory item of the Quality of Life in Alzheimer's Disease, Mini‐Mental State Examination score remained a significant predictor of staff ratings but not self‐ratings in regression analyses. Exploratory analyses of specific cognitive measures showed a significant contribution of a memory test of intentional visual association learning in the prediction of staff‐rated QOL. Conclusions: Staff reports cannot simply substitute reports of the subjective experience of residents with Alzheimer, so both judgments should be taken into account to form an adequate picture of QOL. Staff might be guided more strongly by a cognitive point of view when evaluating QOL of residents with Alzheimer disease, while the latter might have shifted their evaluation standards to cope adequately with the challenges posed by their disease. (Edited publisher abstract)
Adaptation of Flemish services to accommodate and support the ageing of people with intellectual disabilities
- Authors:
- MAES Bea, VAN PUYENBROECK Joris
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 5(4), December 2008, pp.245-252.
- Publisher:
- Wiley
The authors attempted to find out to what extent and in which ways, in Belgium, have Flemish services for people with intellectual disability adapted to the specific needs of aging people. A study was undertaken and a questionnaire was developed to address the following research topics: (1) accommodations and personnel, (2) staff working methods, and (3) staff views and attitudes. The questionnaire was completed by 66 coordinating staff members in as many facilities. At the time of the study, these services supported 310 (27%) persons with Down syndrome age 40 years and older and 833 (73%) persons with intellectual disability (other than Down syndrome) age 55 years and older. Adaptations in accommodation and personnel management were obvious in the majority of the participating services. The working methods reflected a person-centred philosophy, regardless of the age-factor. An exploratory factor analysis revealed three different staff approaches: an activating/socializing, disengaging, and methodical. Participation in activities and involvement in social relations have a prominent place in the staff's views. In general, the authors found that about two-thirds of the services have started to modify their accommodation and personnel to the needs of aging people with intellectual disability. The authors note also that the results suggest there is still a lot of work to do in improving staff training, introducing specific working methods, and in altering stereotypical staff attitudes to assure a good "aging in place."