No description available.

No description available.

This study has been motivated by the need to better understand gender relations in dementia care. Across time and place, gender has been shown to be a fundamental relationship of social organisation. As such, it is hypothesised that gender is likely to have a similarly patterning influence upon relations in residential dementia care. It is argued there is a need to consider the person with dementia as a gendered (and sexual) individual. The study considers the ways that gender produces experiences of a care setting, and how gender is configured by the discourses and practices that characterise dementia care. A dementia care setting also provides a standpoint from which to problematise gender as a widely used but politically sensitive discursive category. The study has been undertaken within the context of a wider investigation of communication and dementia care: Alzheimer's type dementia: Communication Patterns and their Consequences for Effective Care (CPCEC). The research was carried out exclusively within care facilities owned and run by Jewish Care, a voluntary sector organisation offering care and support to the Jewish community. The study takes an exploratory approach to gender relations and is organised according to two main themes. In the first section, attention is paid to hierarchies of identity. A brief review of the historical and socio-political context is offered in order to trace certain themes and key constructions in welfare policy and provision from this wider context to the local settings of the care homes under investigation. It is argued that identity and social experience underpin relationships to a hegemonic perspective in care settings for both residents and staff. The second section is organised according to the theme of interactions. The study makes a contribution to an understanding of care as a situated practice. Drawing upon video data, the dynamic quality of care is underscored and this provides a basis for a conceptualisation of care as an interactive social activity. Gender's connections to other aspects of identity and social experience are also encompassed as another form of interaction. Particular consideration is given to the interconnectedness of gender and sexuality and it is shown that gender shapes the interpretation of sexual expression within dementia care. The dearth of existing research into gender relations and dementia care makes this a unique piece of research, which has more than local implications. Rather, it fills a silence in this area, on both a theoretical and practical level, and promotes both knowledge (theory) and methodological matters to a wide audience. The study holds relevance to formal care settings and similar establishments regarding gender and social relations and beyond, as it adds yet another piece to the 'puzzle' of gender relations in society.

No description available.

Purpose: The number of people with dementia in the UK is known to be increasing. A minority of this group will develop a working age dementia where onset will be prior to 65 years of age. It is suggested that many people with a dementia will be cared for on an informal basis by family or friends. This informal caring role has been shown to be psychologically and physically harmful. If people are to continue to offer the current level of input it is essential that their needs are understood and that they receive the appropriate support from services. Method: A systematic literature search was carried out to determine what was known about caring for those with a dementia. Whilst there was some reference to gender differences in terms of coping styles little of the research had looked at how male carers needs might differ from female carers. To address this gap in the knowledge base a qualitative study was carried out using interpretive phenomenological analysis. The aim of the study was to explore how seven men whose wives developed a working age dementia experienced and perceived their caring role. Results: Five themes emerged from the data: facing up to dementia, challenges to male gander stereotypes, issues of control, using psychological defences and loss. The most significant of these in terms of coping seemed to be perceived control. Whilst the one which appeared to have the most direct impact on the participants was that of loss and the grief process that this brought about. Many of the research findings mapped onto the model of caregiver stress developed by Pearlin et al. (1990) Conclusion: This study helped to expand the current level of understanding about the specific needs of male carers whose wives developed a working age dementia. Furthermore, it highlighted the importance of perceived control over the way in which these men experienced their carer role.

Background: Life story work (LSW) is used within health and social care and has the potential to provide people with: the opportunity to talk about their life experiences; record relevant aspects of individuals' lives in some way; and in doing so use this life story to benefit them in their present situation. Empirical evidence to support LSW use with people with dementia remains scant and most work draws on the perspectives of care staff. Aims: To examine critically the process of undertaking LSW in health and social care; to explore the impact of using LSW on the delivery and outcomes of care for older people with dementia; and to investigate the experience of using LSW with people with dementia from the perspective of care staff, persons with dementia and family carers. Methodology and Methods: After gaining ethical approval, four in-depth case studies involving twenty participants were undertaken employing a constructivist approach. The study was conducted within a large mental health and social care NHS Trust in the North of England. Process consent was taken to recruitment, consent and ongoing involvement. Data were gathered using in-depth semi- structured interviews, formal and informal discussion, observation and a research diary. Data analysis was guided by a framework approach which employed an evolving theoretical framework to interrogate the data. Findings: The findings reveal an enhanced understanding of the process of undertaking LSW and the conditions required for its implementation in health and social care practice. The LSW process and product were found to be of equal importance. A clear link between the use of LSW and the delivery of person- centred care was demonstrated. Family carers valued LSW as a means of upholding the personhood of their relative with dementia; care staff were less able to recognise embodied manifestations of person hood. Conclusion: The empirical evidence on the use of LSW has been extended. A constructivist approach and process consent were found to enable people with dementia to become actively and ethically involved in the research. LSW should be implemented within a planned and systematic approach to reduce any difficulties and to enhance the care offered to people who have dementia and their family carers.

Dementia incorporates a range of serious cognitive and non-cognitive changes including memory loss. People with dementia are vulnerable to getting lost and may require additional support to walkabout safely outdoors. Through a review of the research literature on wandering and getting lost, the thesis examines this complex and contested phenomenon and constructs a 'problem theory.' The evidence-base regarding assessment is examined and a new method of assessment proposed. The value of interventions, including electronic tracking, to promote safe walking outdoors is considered. The thesis is reported in three sections. The first section presents a review and a pilot study of electronic tracking with dementia carers. The study elicited understanding of usage, impact and acceptability and highlighted the need for intervention development to be based on sound research evidence of the phenomenon and its assessment. The second section examines the phenomenon through a review and an observational study of dementia-related police missing-person reports. The study examined incidence, consequences and the risk factors for harm. Results suggest getting lost is a low-frequency event. While harm was rare, the study indicates that the risks increase with age, going missing in winter and length of time missing. An assessment of safety needs to inform decisions about intervention. The third section reports the development of a new method of assessment based on a clear theoretical framework and includes a review and content validity study. The review highlighted the limited attention paid to assessment, including safety, as a means of supporting people with dementia to walkabout outdoors. The study indicated a need for a flexible and inclusive assessment process that seeks to balance safety concerns with quality of life. Further research is needed to understand this complex phenomenon. Identifying the predictors of harm is an important research priority, necessary to support assessment and intervention

In the dementia and food literature, the focus is on eating in institutional settings; from formal caregivers' perspectives (Watson & Green, 2006). The current thesis aims to investigate the phenomenon of dementia and food processes (shopping, preparation and eating) from caregivers' perspectives, using four different research methodologies. In Study la and 1 b, a qualitative study was carried out in which twenty care givers ' narratives on dementia progression and food processes and needs for food services were analysed using Thematic Analysis. Results from Study la revealed a set pattern of decline in dementia and food, as the ability to shop for food declined first, then preparation and lastly the ability to eat declined. Caregivers transitioned into a new food role by adapting to these changes. From Study 1 b results revealed three points of view; most needing information support on food and dementia. In Study 2, in order to assess dementia, food processes and affect it has on satisfaction with food-related life, a quantitative study was designed, operationalised from the results obtained in Study 1. Results indicated a significant relation with adapting to changes more in food shopping and preparation than eating. Also, seeking information and education was significant with satisfaction with food-related life. In Study 3, an audit was conducted to ascertain food and dementia material, using Thematic Analysis. Results revealed that most information was on eating, some on preparation and least on shopping and that materials were scarce. Finally, Study 4a was carried out using a Think-Aloud method, in which two sets of care givers fed back on two different booklets on food and dementia. One booklet was from Study 3 and another newly devised booklet was operationalised from the results obtained from Study la and 3. It was found that care givers judged the new booklet more beneficial, as it contained all food processes. It is concluded that by receiving focused information and support services as dementia progresses, care givers and the cared for can maintain satisfaction with food-related life.

This study set out to acknowledge the voices of carers of people with dementia and to incorporate this into the present literature regarding dementia. The study therefore sought to ask: How do professional care staff construct challenging behaviour amongst residential and nursing home residents living with dementia? Interviews were conducted with twelve care staff working m residential and nursing homes and their transcripts were subjected to Foucauldian Discourse Analysis. Close examination of the data suggested four main discourses that were used interchangeably by all participants: The dualistic nature of dementia, causal explanations, challenging behaviour as a form of self-expression and the management of the disorder. It is thought that these discourses were drawn upon by participants to open and close the dialectical gap between 4healthy' staff and 'unhealthy' people with dementia. The researcher suggests that this may highlight the prevalence of 'othering' in care practices in addition to implications for identity formation and the management of blame and responsibility. It is argued, amongst other issues, that in order to achieve national dementia objectives (DoH, 2009; 2010), training of care staff should focus on the language and discourses drawn upon by staff Specifically, the use of 'distress reaction' should be considered as an alternative to 'challenging behaviour' to open up new opportunities for thinking and care practices. Furthermore, it is suggested that clinical psychologists have a leadership role to play in ensuring staff are reflecting on the influence their language may have on their clinical practice and in the constitution of an effective culture of care.

In the UK, the number of people with dementia is increasing along with life expectancy - over half of the £23bn annual cost of dementia is due to informal care time. Therefore, there is an economic argument for identifying clinically-effective and cost-effective ways to maintain and improve carer quality of life (QoL). This thesis explores the suitability of a capability based instrument, the ICECAP-O, for measuring QoL in informal carers of people with dementia. Methods: Systematic reviews, qualitative interviews, survey data and clinical trial data were used. Construct validity of the ICECAP-O was examined using baseline data from the Challenge FamCare study of people with dementia and challenging behaviours, and an online survey created to collect additional data. A cost-effectiveness analysis was undertaken using a subsample of carers in the REMCARE trial of joint-reminiscence therapy (RT). Results: The current evidence base for interventions to support carers of people with dementia is poor, with few economic evaluations existing. Qualitative work found the major themes affecting carer QoL overlapped well with capability instruments, suggesting this framework is suitable for carer research. Validity work found the ICECAP-O to be feasible and valid for use with carers. At the end of the 10 month RT trial, the mean difference in ICECAP-O scores between groups was -0.02 (bootstrapped 95% Cl of -0.1 05 to 0.066) and the mean difference in costs was £1 ,464 (bootstrapped 95% Cl of £758 to £2,313), RT was dominated by usual care. The cost-effectiveness acceptability curve indicated a 2% probability that RT was cost-effective at a willingness to pay threshold of £20,000 per point improvement and an 8% probability that RT was cost-effective at a threshold of £30,000 per point improvement on the ICECAP-O.