Dementia

This study used a standardized instrument, the Royal Free Interview for Religious and Spiritual Beliefs, to investigate the spirituality of a population of people with dementia who scored 12 or more on the Mini Mental State Examination and their carers, who were attending a West Midlands Memory Clinic. Study patients were more likely to be well preserved cognitively, be female, and to be living with their spouse at home, than the clinic population as a whole. The population was predominantly white British and Christian. Both patients and carers found the Royal Free Interview acceptable: they rated their beliefs as strong and considered practices associated with their beliefs to be very important. Both groups described spirituality as evident in everyday experiences and as supportive in relation to life stresses. Service providers should integrate questions about spirituality and faith into routine assessments and structure care plans to accommodate identified spiritual needs.

Research on family caregivers usually focuses more on stress and burden, especially in the context of looking after a person with dementia. This leads to fewer considerations of positive aspects of caregiving. Thus enhancing these positive aspects represents an innovative approach to caregivers’ support. Furthermore, these aspects need more conceptualization to underpin the development of such an approach. This article proposes a conceptual framework of the positive aspects of caregiving based on an integrative literature review. This conceptual framework provides a comprehensive model that should improve understanding of positive aspects of caregiving. It could also contribute to the development of innovative support programs based on the positive aspects instead of the negative aspects of caregiving.

A growth model within the framework of hierarchical linear modeling was used to assess the impact of visiting a wander garden on monthly agitation levels of a group of elderly veterans diagnosed with dementia, with attention to their ambulatory ability. A sample of 34 veterans residing in a locked ward in a dementia unit was observed for a baseline period and for twelve months after a wander garden was opened in their facility. Findings suggest that visiting the wander garden helped lower agitation levels in the dementia patients and that there was a differential effect based on the patient’s ability to walk unassisted.

Background: Pain has been identified as a significant and under-reported problem in the older adult and those persons with dementia who may face an impaired ability to communicate that they are in pain. Their pain, under-diagnosed and under-treated, has functional implications, such as decreased ambulation, mood and sleep disturbances, impaired appetite and exacerbation of cognitive functioning. Methods: Resident Assessment Instrument (RAI) data were analyzed in order to 1) identify a pain profile of all of the residents living in the facility across two sampling periods (December 2005 and December 2006) and 2) compare the pain profile of residents categorized into two subgroups (intact communication/impaired communication). Findings: Consistent with the literature, clear differences were demonstrated between pain reporting and management for communication impaired residents with dementia and residents with intact communication. Several incongruent findings were also demonstrated. Conclusions: The RAI is useful to identify patterns but insufficient in itself for pain management purposes in this vulnerable group. Pain assessment tools developed for this population must be employed.

The authors studied a group of older carers of aging adults with Down syndrome (DS) to ascertain what effects such caregiving may have on them given the presence or possibility of age-associated decline or dementia. The study also examined the comparative levels of care provided, key signs noted when decline was beginning, the subjective burden experienced, and what were the key associated health factors when carers faced a changed level of care. The authors found that this group was made up of long-term, committed carers who have decided early on to look after their relative with DS over their lifetime. When faced with the onset and ongoing progression of dementia, their commitment was still evident as evidenced by adopting physical accommodations and finding ways to continue to provide care at home, while also seeking help from outside sources. Most saw a family or group home environment as the place of choice for their relative with DS when they decided they could no longer offer care. The study did not ascertain any burn-out or significant health related problems associated with their continued caregiving save for their concerns about day-to-day strain and what will happen in the future.

Although heralded as a major breakthrough in the treatment of Alzheimer’s disease the experience and impact of using cholinesterase inhibitors (CHEIs) from the perspective of people with Alzheimer’s disease has not been widely reported. This qualitative study reports the lived experience of CHEI users and the perceived impact of the treatment. The views and experiences of 12 older people referred for memory problems or receiving treatment and 11 associated family carers were obtained using a combination of semi-structured interviews and focus groups. A key theme that emerged from the qualitative analysis was the belief that any new treatment ‘is worth a try’. For some participants the benefits of using CHEIs were ‘difficult to say’. Others reported seeing ‘a difference’, ‘getting no worse’ or no improvement in their symptoms. The study highlights the importance of listening to the voices of people with dementia and their family carers in the management of pharmaceutical treatments and the need to involve (potential) treatment users in defining quality-of-life outcomes in cost-effectiveness studies.

Between 2001 and 2006 UK guidance recommended that people with mild to moderate Alzheimer’s disease were eligible for treatment with donepezil, rivastigmine and galanatamine on the National Health Service (NHS). However, there was considerable variation in uptake of and access to treatment. This qualitative study aimed to understand which factors influence decisions to initiate, continue and discontinue treatment with the drugs. The views and experiences of 12 older people referred for memory problems or receiving treatment, 11 family carers and 16 health and social care professionals were obtained using a combination of semi-structured interviews and focus groups. Four factors outside UK guidance and prescribing budgets influence decisions to utilize the drug treatments, namely: perceptions of treatment availability and effectiveness; resource capacity; carer perceived benefits; and professional ethics. Unequal access to treatment and ethical concerns remain key issues.