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Dignity in care: communication
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2014
- Pagination:
- 16 minutes 7 seconds
- Place of publication:
- London
Good communication can help people to maintain their dignity. It is vital that staff develop other ways of communicating with people who have a cognitive impairment or limited speech. This film provides an example of communicating with Matthew, a young man with Down's Syndrome Matthew is encouraged to use a diary so that he knows what he's going to be doing on any particular week. It's a good way for staff to find out what's been happening in Matthew's life. The film also shows how, for older people, past memories of being at the beach can be used as a useful communication tool. Communication in practice can mean asking people how they prefer to be addressed and to respect their wishes; giving people information about the service in advance and in a suitable format; and not assuming that you know what people want because of their culture, ability or any other factor. (Edited publisher abstract)
Knowingly not wanting to know: discourses of people diagnosed with mild cognitive impairment
- Author:
- PEARCE Sian
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 15(5), 2016, pp.1246-1259.
- Publisher:
- Sage
Mild cognitive impairment is a heterogeneous clinical state whereby assessed cognitive changes over time may progress to dementia, remain stable or revert to back to normal. This study aimed to identify, through discourse analysis, how people with a diagnosis of mild cognitive impairment used language in order to reveal the societal views and shared meanings of the diagnosis, and the positions taken by people. Seven people with mild cognitive impairment were interviewed, and three discourses emerged during analysis. One of the discourses revealed was ‘Not Knowing’ about mild cognitive impairment. Furthermore, in the absence of a coherent discourse related to mild cognitive impairment, participants went on to position themselves between two more familiar discourse; ‘Knowing’ about ageing and dying and ‘Not Wanting to Know’ about dementia. Clinicians must consider how information is presented to people about mild cognitive impairment, including where mild cognitive impairment is positioned in respect to normal ageing and dementia. (Publisher abstract)
'Oh he was forgettable': construction of self identity through use of communicative coping behaviors in the discourse of persons with cognitive impairments
- Authors:
- SAUNDERS Pamela A., MEDEIROS Kate de, BARTELL Ashley
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 10(3), August 2011, pp.341-359.
- Publisher:
- Sage
The focus of this study undertaken in Washington DC was examining and analysing the verbatim linguistic utterances of people with cognitive impairments to describe and compare communicative coping behaviours. The communicative coping behaviours used by individuals with cognitive impairment to present a positive self identity may include memory and health accounts (the way people explain, excuse and/or justify their behaviour) and humour. Two groups of participants aged 65 years and over were recruited: 31 patients with cognitive impairment and 29 patients without cognitive impairment. Clinical encounters between doctors, patients, and third-party companions during routine examinations at the Georgetown University Hospital Neurology Department were observed, recorded and transcribed. The article presents the results of the analysis, with examples from the transcripts, looking at memory accounts, health accounts, and humour exchanges. The results showed that participants with cognitive impairment used more memory accounts than cognitively normal individuals and similar amounts of humour in order to save face and construct a normal identity. The authors note that despite memory impairment, people with cognitive impairments contributed to conversations during their clinical visits and were able to present themselves as productive members of the interaction. They conclude that people with cognitive impairment adapt to their communicative disadvantage and that it is important for doctors and carers to recognise these coping strategies.
Dementia: 'a death of the mind'
- Author:
- TERRY Paul
- Journal article citation:
- Therapy Today, 21(8), October 2010, pp.20-24.
- Publisher:
- British Association for Counselling and Psychotherapy
This paper, written from a psychodynamic perspective by a clinical psychologist lead for older people within a UK NHS Specialist Community Mental Health team, describes the early, transition and advanced stages of dementia and the care of those suffering from increasing memory problems through to loss of independent capacity for language and bodily functions, respectively. Carers of those with dementia may have unconscious and unmanaged fears, which could impact upon the sufferers’ quality of life and add to their distress, a process known as ‘projective identification’ which is described. An example from a dementia care dayroom is quoted by way of illustration. The article goes on to discuss “the value of understanding and support” and “helping to bear what is unbearable” and quotes the research and practice of many others in this field.
How volunteers can help with early memory loss
- Author:
- DAVISON Kirstie
- Journal article citation:
- Journal of Dementia Care, 9(3), May 2001, pp.13-14.
- Publisher:
- Hawker
Describes a project which aimed to identify the information and help needed by people living in a rural area with memory problems and a possible diagnosis of dementia, and the contribution volunteers can bring.
The relationship between cognitive function and performance in instrumental activities of daily living in older adults
- Authors:
- TOTH Cheryl, et al
- Journal article citation:
- British Journal of Occupational Therapy, 85(2), 2022,
- Publisher:
- Sage
Introduction: Deficits in cognition have been found to be associated with problems in performing daily activities; however, it is unknown what specific domains of cognition are related to each daily activity. Method: Thirty-six occupational therapists identified the 20 most important instrumental activities of daily living for older adults and the cognitive demands required. Thirty-two older adults rated the perceived mental effort when performing these activities. They were assessed on their cognitive functions. Descriptive statistics were used to report the results. The Pearson correlation coefficient was used to identify relationships between cognitive functions and perceived mental effort. Results: Activities relating to 'communication', 'financial management', 'health management' and 'safety and emergency management' require more cognitive demands. Results from the older adults showed the highest significant correlations in immediate memory and 'paying bills' (r = 0.54), delayed memory and 'following emergency procedures' and 'paying bills' (rs = 0.52), and executive functioning and 'making and keeping medical appointments' (r = -0.49). Conclusion: Findings contribute to the emerging understanding of specific cognitive domains related to the instrumental activities of daily living. The results can be used to reframe and improve intervention strategies for individuals with cognitive decline to maintain or improve performance in daily activities. (Edited publisher abstract)
Overcoming elderspeak: a qualitative study of three alternatives
- Author:
- CORWIN Anna I.
- Journal article citation:
- Gerontologist, 58(4), 2018, pp.724-729.
- Publisher:
- Oxford University Press
Purpose: This study identifies genres of communication that avoid the features of elderspeak and successfully engage cognitively or physically affected older adults in rich communicative interaction. Design and Methods: The study examined 100 hr of audio- and video-recorded interaction between older Catholic nuns and their caregivers. The data were collected as part of a 7-year study on the linguistic and communicative factors that contribute to successful ageing in a Catholic convent infirmary. Data analysed in this article were selected from the corpus based on 2 criteria: (a) the interaction was absent of elderspeak and (b) the interaction was between a communicatively or cognitively impaired older adult and a caregiver. Results: Linguistic analysis of the interactions revealed 3 alternatives to elderspeak that maintain lexically and grammatically rich communication while maintaining minimal opportunity for communicative failure or breakdown. These include: (a) offered and requested blessings, (b) jokes, and (c) narratives. Implications: These 3 communicative strategies offer examples of lexically and grammatically complex ways to communicate with older adults who have little other opportunity for similarly complex interaction and may reduce resistiveness to care, and linguistic isolation, which has been linked to cognitive decline. (Edited publisher abstract)
A comparison of cognitive functioning in long-term care and short-stay nursing home residents
- Authors:
- MANSBACH William E., et al
- Journal article citation:
- Ageing and Society, 37(1), 2017, pp.1-13.
- Publisher:
- Cambridge University Press
It can be challenging to provide person-centred care for individuals with cognitive impairment if they are unable to communicate their needs to facility providers clearly. The high base rates of dementia and mild cognitive impairment (MCI) in US nursing homes is well documented; however, our understanding of the unique prevalence of cognitive levels in long-term care and short-stay residents is limited. The aim is to determine whether there are significant differences in specific cognitive levels between these two groups. Long-term care and short-stay residents (N = 579) were randomly selected from 18 Maryland, US skilled nursing facilities; 345 met inclusion criteria for participation (mean age 79.41) and completed a cognitive test (Brief Cognitive Assessment Tool (BCAT)). Based on BCAT scores, 78.9 per cent of the long-term care residents had dementia compared to 61.4 per cent for short-stay residents. The proportions of MCI, mild, and moderate to severe dementia were significantly different between the two groups (p = 0.00). The odds of residents having moderate to severe dementia were 2.76 times greater for long-term care compared to short-stay residents. BCAT total and factor scores were significantly different between long-term care and short-stay nursing home residents (p < 0.001). The authors discuss the implications of these empirical findings in terms of facilitating person-centred care in nursing homes. (Publisher abstract)
Learning and using technology in intertwined processes: a study of people with mild cognitive impairment or Alzheimer’s disease
- Authors:
- ROSENBERG Lena, NYGARD Louise
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 13(5), 2014, pp.662-677.
- Publisher:
- Sage
People with mild cognitive impairment and Alzheimer’s disease are likely to be challenged by the multitude of everyday technology in today’s society. The aim of this study was to explore how they try to prohibit, avoid or solve problems in everyday technology use, maintain skills, and learn to use new technology. To explore how the participants applied and reasoned about using everyday technology in real-life situations interviews were conducted while the participants used their own technology in their homes. Interviews were conducted with 20 participants with mild cognitive impairment (n = 10) or Alzheimer’s disease (n = 10). The analyses were inspired from grounded theory and resulted in one core category and three sub-categories that represent sub-processes in the core. The core finding presents a continuous, intertwined process of learning and using everyday technology, highlighting how the context was interwoven in the processes. The participants used a rich variety of management strategies when approaching technology, including communication with the everyday technologies on different levels. The findings underscore that it is important to support continued use of everyday technology as long as it is valued and relevant to the person with mild cognitive impairment or Alzheimer’s disease. The intertwined process of learning and using everyday technology suggests how support could target different sub-processes. (Publisher abstract)
A longitudinal study of neuropsychological change in individuals with Parkinson's disease
- Authors:
- AZUMA Tamiko, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(12), December 2003, pp.1115-1120.
- Publisher:
- Wiley
Neuropsychological changes in individuals with Parkinson's disease (PD) were studied longitudinally. Sixty-nine idiopathic PD patients, with Mini-Mental State Examination (MMSE) scores falling within normal range, and 37 elderly control participants were given neuropsychological tests twice approximately two years apart. The PD group performed poorer than the control group on Semantic Fluency, Letter Fluency, Modified Wisconsin Card Sorting Task, and Block Design at test time 1. Two years later, the PD group showed significant decline in Semantic and Letter Fluency. A subset of 12 PD patients declined in mental status by second testing (>4 MMSE points). Cox proportional-hazards models were used to see if any baseline measures were associated with relative risk of decline in mental status. In the final model, Repetition performance and Age were significantly associated with cognitive decline. Consistent with previous studies, executive function tasks were those most susceptible to disease progression.