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Alzheimer's disease and the law: positive and negative consequences of structural stigma and labelling in the legal system
- Authors:
- WERNER Perla, DORON Israel (Issi)
- Journal article citation:
- Aging and Mental Health, 21(11), 2017, pp.1206-1213.
- Publisher:
- Taylor and Francis
Objective: To explore the meaning and consequences of labelling on structural stigma in the context of Alzheimer's disease (AD) in the legal system. Method: This qualitative study was made up of three focus groups including social workers and lawyers (n = 26). Participants were asked to report their experience in circumstances in which persons with AD and their family members engage with the legal system. Thematic analysis using the constant comparative method was used. Results: The discussions in the focus groups raised two overall themes. (1) The significance of the medical diagnostic labelling of AD in the legal system and (2) the consequences of labelling of AD within the legal system. This last theme included four sub-themes: (a) negative consequences of labelling; (b) reasons associated with negative consequences of labelling; (c) positive consequences of labelling; and (d) reasons associated with positive consequences of labelling. Conclusion: Findings of the study provide a first foundation for future research on the meaning and consequences of labelling in legal cases involving persons with AD. They suggest that increasing judges' knowledge about AD and reforming the existing ‘status-based’ legal capacity legislation might benefit by limiting the legal weight given today to the medical diagnosis. (Edited publisher abstract)
Emotional reactions of lay persons to someone with Alzheimer's disease
- Authors:
- WERNER Perla, DAVIDSON Michael
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(4), April 2004, pp.391-397.
- Publisher:
- Wiley
Information about the nature of public reactions to people with Alzheimer's disease (AD) can help reduce stigmatization associated with the disease. The aim of this study was to examine emotional reactions to persons with AD, and its correlates. A total of 150 Jewish Israeli adults (mean age=59.9) were interviewed face-to-face regarding their emotional reactions to people with AD using a vignette methodology. Only a third of the participants gave the correct label. The person described in the vignette elicited more positive than negative emotions. Gender and perceived threat were the most important factors associated with emotional reactions. Findings suggest the need to expand the efforts to increase the recognition of AD by lay persons, and to address the negative emotions of several risk groups, such as male adults and those with greater concern about developing the disease.
Anxiety disorder and accompanying subjective memory loss in the elderly as a predictor of future cognitive decline
- Authors:
- SINOFF Gary, WERNER Perla
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(10), October 2003, pp.951-959.
- Publisher:
- Wiley
The aim of the study was to empirically investigate the hypothesis that anxiety in the elderly, secondary to loss of memory, predicts future cognitive decline. The participants were 137 elderly subjects with no depression or cognitive impairment from a community geriatric assessment unit, 45% with anxiety. In addition to demographic characteristics, cognitive status was assessed using the Mini Mental State Examination; depression was assessed by Tucker's short Interviewer-Assisted Depression Rating Scale; anxiety by Sinoff's Short Anxiety Screening Test and Activities of Daily Living function by Shah's modified Barthel's Index. At follow-up 37 persons had dropped out, leaving 100 participants for final analysis. Mean re-examination time was 3.2 years with no group differences. The mean MMSE and modified Barthel scores decreased significantly more in those with anxiety. A relative risk of 3.96 for developing future cognitive impairment was found. Regression analysis showed that only anxiety was a significant predictor of cognitive decline. By path analysis, a more parsimonious model showed anxiety to have both a direct and an indirect effect on predicting future cognitive decline, and that the effect of loss of memory on cognitive decline was via anxiety. Anxiety is inter-related and inseparable with loss of memory and its presence is a strong predictor for future cognitive decline, directly or indirectly via depression. It appears that loss of memory is the initial problem with consequent development of anxiety. Therefore, anxiety, like depression, is probably an early predictor of future cognitive decline and even possible future cognitive impairment.