The aim of this littrature review has been to describe how you can satisfy the need of nourishment for older people who suffer from dementia. Data has been retrieved by searches in Academic Search Elite, Sience Direct, Blackwell, PubMed and in the Journal Vård i Norden. The studies show that most of the people with dementia have a hard time to satisfy the nourishment. The results show that through different preventive measurement you can improve the nourishment for these people, to set the table, play calm music and to have a table companion. By taking the food oneself created a good meal environment and the individually need was provided for. A good oral status improved the nutritional status. Patients who got nourishment addition put on weight or retained their weight. Nursing staff wished and needed more education in nutrition for older people with dementia.

Syftet med studien var att beskriva hur vårdtagarens samt vårdpersonalens agerande/beteende, (verbalt/kroppsspråk) påverkade matintaget hos demenssjuka vårdtagare. Hur omgiviningsfaktorer påverkade matintaget har också observerats. En observationsstudie genomfördes på en demensavdelning under 5 luncher med hjälp av en observationsmall. Resultatet visade på att de flesta verbala påpekanden/instruktioner från personalen gavs till vårdtagarna de luncher då de åt minst, samt att personalen visade på stor följsamhet gällande att känna av hur vårdtagarna önskade hjälp under måltiderna. Interaktionen mellan vårdare/vårdtagare upplevdes "tryggt". Beteenden som kunde observeras hos vårdtagarna var att 2 av dem somnade några gånger under måltiderna, samt att sväljproblem förekom hos 2 av dem. Omgivningsfaktorerna påverkades av "gamla" rutiner som fanns kvar på boendet sedan förut. Att maten lades upp på diskbänken, att tillbehör till maten inte fanns på bordet/erbjöds vanemässigt till vårdtagarna (dessa lades också upp på bänken) kan eventuellt påverka matintaget negativt. Matintaget varierade mellan 30-100% hos vårdtagarna under de 5 luncherna. Slutsats: Personalens bemötande av demenssjuka personer påverkades av dennes erfarenhet av dem och vilken relation de hade. Kände vårdtagaren och vårdgivaren varandra, uppstod ett samspel, som underlättade vid måltiden/matsituationen vilket påverkade matintaget positivt. Måltidsmiljön hade också stor betydelse för matintaget, den påverkade också trivseln runt måltiden.

Smärta påverkar människans livskvalitet och medför både fysiskt och psykiskt lidande. En demenssjukdom ger såväl fysiska funktionsnedsättningar som psykosociala beteendeförändringar.I omvårdnaden av patienter med demenssjukdom finns svårigheter med att identifiera och bedöma smärta på grund av de funktionsnedsättningar sjukdomen innebär. Studiens syfte är att undersöka hur vårdare identifierar och bedömer smärta hos demenssjuka patienter. Metoden är en litteraturstudie. Datamaterialet innehåller 13 vetenskapliga artiklar. I analysen av datamaterialet framkommer fem kategorier vilka ligger till grund för resultatet. De kategorier som framkommer ur analysen är: bedömningsinstrument, fortsatt utveckling och testning av bedömningsinstrument, kommunikation, patientkännedom och vårdarens kunskap. Resultatet visar att smärtidentifiering är ett komplext problem, där självskattningsskalor och observationsskalor kan användas för bedömning, liksom kommunikationens betydelse samt patientkännedom och vårdarens kunskap. Därför blir daglig omvårdnad ett viktigt identifieringsverktyg. Diskussionen visar att det finns svårigheter i tolkningen av patientens uttryck. Bedömningsinstrumenten behöver också utvecklas och testas ytterligare, för att anpassas till patientens behov. Slutsatsen är att bättre utvecklade bedömningsinstrument samt ökad kunskap om demenssjukdomar leder till säkrare identifiering och bedömning. / Pain has an influence in the individual`s lifequality. Pain also involve suffering in both physically and mentally sense. To suffer from dementia means cognitive disorders and impairments. In caring of patients suffering from dementia there are difficulties in identifying and assess pain because of these impairments. The aim of this study is to do researching in how caregivers identify and assess pain in patients suffering from dementia. For this research a literature study has been used. The matter of data contains 13 articles of sciense quality. In the analysis of the study five categories appeares; instruments for assessment, further research of instruments, communication, knowledge in patient and caregivers knowledge. The result presents the complexity of identifying pain and also points out several factors as important. Selfassesment scales and observational scales can be used, as well as the importance of communication and knowledge about the patient. Caregiver`s knowledge are important, too. The discussion points out difficaulties in interpreting the patients expressions. Also further development and testing of the instruments are necessary, to adapt to the patients needs. Conclusions are that further developing and testing of pain assessment are needed as well as increased knowledge in dementia diseases. This leads to safer identifying of pain in patients with dementia.

Abstract The aim of the study was to describe the level of understanding of nursing staff regarding the expression of pain by patients suffering from dementia. A further aim was to examine what help and support is available to nursing staff in aiding assessment of pain levels in these patients. The study is descriptive in character and has a qualitative perspective. Six interview subjects, who were strategically chosen for convenience, were selected to help in this study. The criteria used for selection was that all should have a minimum of three years experience caring for patients suffering from dementia. As an aid to the interview process, semi structured questions and an interview guide were used. The material gathered was then literally transcribed, analysed and divided into eight categories and sub categories. Interviewees report that patient express pain in a variety of different ways. Some patients use body language where they become withdrawn and their facial expressions and posture alters. Mood changes are also described, with patients becoming restless and anxious and sometimes aggressive. Verbal expressions of pain, such as wailing and screaming, are also described as well as the observation that patients suffering from dementia sometimes develop difficulties in sleeping and can wander off. Further observations from the study show that combined importance of really knowing and being familiar with the patient and his/her background, a good relationship between nursing staff and the patients relatives, and finally, the need of pain assessment tools.

Bakgrund: Antalet personer med demenssjukdom i Sverige beräknas uppgå till 150 000. Utav dessa vårdas 55 procent i hemmet av anhöriga. De anhörigas roll och funktion som vårdare i hemmet blir alltmer centralt, då vård och omsorg flyttas från det offentliga rummet till det privata. Att träda in i rollen som anhörigvårdare förändrar livssituationen avsevärt och allt planeras kring demenssjukdomens villkor. Syfte: Att sammanställa och belysa forskning som beskriver hur de anhöriga upplever sin situation av att vårda en anhörig som drabbats av en demenssjukdom. Metod: En litteraturöversikt där fem kvantitativa och sex kvalitativa artiklar analyserats. Resultat: Artikelanalysen resulterade i tre teman:  en ny livssituation, förändrad relation och känslomässigt påfrestande. I resultatet framkom att anhöriga rapporterade ohälsa. Diskussion: Anhöriga är en utsatt grupp, som behöver mycket stöd för att de ska orka axla rollen som anhörigvårdare. För att de ska kunna ge den demenssjuke god vård, krävs ett samarbete mellan den anhörige och vården. Kunskapen i studien är användbar för sjuksköterskan och kan användas som ett verktyg för ökad förståelse i mötet med den anhörige. / Background: The numbers of people with dementia in Sweden are estimates at 150 000. Out of these 55 percent cared for a relative at home. The role and function as a caregiver in home are becoming more centralized, when health care move from the public sphere to private enter the role of careers changing life situation considerably and everything is planned around the dementia illness. Aim: To collate and illustrate research that describes how the relative experiences their situation of caring for a relative with dementia. Method: A literature survey in which five quantitative and six qualitative articles were analyzed. Results: Article analysis resulted in three headings: a new life situation, changes in relationships and emotional trying. The results revealed that caregivers reported illness. Discussion: Relatives are a vulnerable group in need of much support to maintain the role as a caregiver. To be able to provide the best dementia care requires a coperation between caregivers and health care. Knowledge in the study is useful for the nurse and can be used as a tool for better understanding of the meeting with the relative.

It is well established that there are many intrinsic and extrinsic risk factors associated with falls in older adults. Less well-known is what risk factors predict falls in more vulnerable populations, such as those with neurological conditions living in long-term care homes or receiving home care services. Furthermore, evidence comparing those with neurological conditions to those without is lacking in the literature. The primary purpose of this thesis was to determine risk factors for falls in long-term care residents and home care clients with no recent history of falls to determine if risk factors differed between individuals with dementia or Parkinson’s disease and those without any neurological conditions. Secondary data analysis was performed on a database of standardized health assessments completed for long-stay home care clients and long-term care residents in Ontario. Within each major diagnostic group, observations were stratified based on ambulatory status (ambulatory vs. non-ambulatory). Bivariate analyses followed by generalized estimating equations were used to determine statistically significant predictors of falls in each group within each care setting. The results of multivariable analyses showed that there is not a distinct set of risk factors associated with falls in home care clients and long-term care residents with dementia or Parkinson’s disease that is systematically different from risk factors associated with falls in clients and residents not diagnosed with any of the neurological conditions in this study. These results suggest that a common set of risk factors may effectively predict falls in all clients and residents with no recent falls history, regardless of certain neurological diagnoses.

Recent publications have urged researchers to address neuropsychological assessment issues among culturally and linguistically diverse individuals for whom current assessment measures are not typically appropriate. This dissertation examined cultural considerations in clinical neuropsychological practice with Cree-speaking Canadians residing in Saskatchewan. Four inter-related studies focused on understanding cultural perceptions of normal aging and dementia within a Canadian Aboriginal population, modifying existing screening and neuropsychological assessment instruments for use in both normal aging research and clinical practice, and investigating the role of culture in cognitive aging with Cree-speaking. Study 1 involved the qualitative analyses of a series of key informant interviews with an Aboriginal Grandmothers Group. Three related themes were identified that highlighted Aboriginal experiences of aging, caregiving, and dementia within the healthcare system. The third theme, the importance of culturally grounded healthcare, directly informed test development for Studies 2 and 3. In Study 2, two screening measures that were adapted for use with seniors from diverse cultural groups were further modified and examined for use with Canadian Aboriginal seniors. Overall, performance was consistent across the two screening measures, and the measures informed clinical diagnosis and were well-received by both the Aboriginal patients and their family members. Study 3 describes the development of the Grasshoppers and Geese Test battery (G&G), created by modifying and integrating existing instruments and paradigms for language and memory assessment for use with culturally diverse seniors. All G&G subtests demonstrated adequate preliminary psychometric properties and generated excellent sensitivity and good specificity in differentiating healthy older adults from adults with Alzheimers disease. Finally, Study 4 examined performance on the G&G and on other neuropsychological measures in groups of young-middle aged and older adults from majority culture and Cree background. Cree participants mean scores were lower on measures of confrontational naming, semantic memory, verbal fluency, prospective memory, and processing speed, and were presumed to be in keeping with the significantly fewer years of education, lower estimated reading ability, and possible health disparities in the participants of Cree background. Findings of the four studies are discussed in the context of implications for current clinical practice and with regard to future research.

Alzheimer disease (AD) and related dementias affect nearly one in thirteen Canadians over the age of 65. Difficulties in communicating are frequently cited as the greatest source of stress for individuals who have a diagnosis of dementia and their families. Despite the wide recognition that the family is affected by a relative’s diagnosis of dementia, there has been little research aimed at understanding the experience of the family as a unit. The purpose of this study is to gain insight into the family experience of communicating with a relative who has dementia. This study used a qualitative single case study design, drawing on the theory of Symbolic Interactionism. Three members of one family participated in two individual interviews and a family interview. The family member who was experiencing symptoms associated with AD but whose diagnosis was referred to as “cognitive impairment” (CI), participated in one individual interview. Interviews were transcribed and the data was analyzed using constant comparative analysis. The findings that emerged from the data indicate that the participating family approached communication with the intention of achieving three particular goals in their interactions. These goals were to include, protect, and bring happiness to their afflicted family member. Three strategies were identified as the primary strategies used to achieve these goals: interpreting, scripting, and translating. Further, the family was organized in such a way that members were positioned either as part of the ‘core’ of the family or on the ‘outskirts’ of the family. Family members that pursued and achieved the three goals in their interactions with the relative who has CI were considered to be part of the core while others who were not willing or capable of interacting in this way were positioned on the outskirts of the family. Understanding the communication experience of the family as a unit offers a vital link to meet the needs of families dealing with the effects of CI. This knowledge will aid in formulating important new questions and insights for researchers and clinicians to provide the care and support necessary to promote the well-being of families affected by CI.

Most persons with a dementia are cared for in the home by family members who experience a broad and considerable amount of stress and whose caregiving careers may include planning for or initiating moves to memory care units (MCUs). This study examines the decision-making processes of primary informal caregivers regarding their care recipients' moves to MCUs. Grounded theory methods were used to collect and analyze data in two long-term care (LTC) facilities varying in characteristics including capacity, state licensure, fees, and resident profiles. Specific aims are two-fold: 1) advance an understanding of how primary informal caregivers of persons with a dementia made decisions for formal memory care, and 2) identify the important factors related to the decision-making process.

Recent publications have urged researchers to address neuropsychological assessment issues among culturally and linguistically diverse individuals for whom current assessment measures are not typically appropriate. This dissertation examined cultural considerations in clinical neuropsychological practice with Cree-speaking Canadians residing in Saskatchewan. Four inter-related studies focused on understanding cultural perceptions of normal aging and dementia within a Canadian Aboriginal population, modifying existing screening and neuropsychological assessment instruments for use in both normal aging research and clinical practice, and investigating the role of culture in cognitive aging with Cree-speaking. Study 1 involved the qualitative analyses of a series of key informant interviews with an Aboriginal Grandmothers Group. Three related themes were identified that highlighted Aboriginal experiences of aging, caregiving, and dementia within the healthcare system. The third theme, the importance of culturally grounded healthcare, directly informed test development for Studies 2 and 3. In Study 2, two screening measures that were adapted for use with seniors from diverse cultural groups were further modified and examined for use with Canadian Aboriginal seniors. Overall, performance was consistent across the two screening measures, and the measures informed clinical diagnosis and were well-received by both the Aboriginal patients and their family members. Study 3 describes the development of the Grasshoppers and Geese Test battery (G&G), created by modifying and integrating existing instruments and paradigms for language and memory assessment for use with culturally diverse seniors. All G&G subtests demonstrated adequate preliminary psychometric properties and generated excellent sensitivity and good specificity in differentiating healthy older adults from adults with Alzheimers disease. Finally, Study 4 examined performance on the G&G and on other neuropsychological measures in groups of young-middle aged and older adults from majority culture and Cree background. Cree participants mean scores were lower on measures of confrontational naming, semantic memory, verbal fluency, prospective memory, and processing speed, and were presumed to be in keeping with the significantly fewer years of education, lower estimated reading ability, and possible health disparities in the participants of Cree background. Findings of the four studies are discussed in the context of implications for current clinical practice and with regard to future research.