Background: The amount of elderly patients who’s suffering from dementhia increases every year. Many of these patients develop and decrease in their cognitive ability. The development can lead to people's communication skills deteriorate. It can be a problem for the nurse to communicate with these patients. It´s there fore of great importance for the nurse to learn communiations skills that can increase the communication with elderly patiants suffering from dementia. Aim: The aim of this study is to illuminate the significance of communication in nursing care of elderly patients with dementia. Which communication strategies can the nurse use and what are the consequences for nursing care? Method: To study the selected study area a litterature review was selected. This review was based on five qualitative articles, five quantitative articles and one qualitative-quantitative article. The authors looked for differences and similarites in results of the articles. Results: The results showed that the communication was of great significance in the nursing care between nursing staff and older patients with dementia. It showed that specific communication strategies increaseed many of the patients security, participation and facilitated cooperation between nursing staff and the patients with dementia. Three main themes emerged from the articles: the spoken language, music and pictures. Conclusion: By using specific communication strategies nurses could help patients to express themselves and participate in nursing care and conversations.

Constipation is a common problem for people with dementia and it may result in discomfort, suffering and lower quality of life. Nurses in municipal nursing homes have difficult to observe and prevent these problems because they do not participate in the daily caring work. The aim of this study was to illustrate the nurse assistants’ reflections about the care they gave people with dementia and constipation. Main questions vas how they became aware of such problems and what they did when someone had problem with constipation. It also asked about their methods to prevent constipation and if they thought anything could be done better in the future. The method used was a qualitative interview study. The study included eight nurse assistants who worked in municipal nursing homes for people with dementia. The interviews where tape recorded, then written and analysed with a phenomenological method. The result illustrate how the nurse assistants used their sense for observing and their personal feelings to share the experience with the person. This gave trust and renders possibility to get knowledge and also gave opportunity to prevent problems and give help, in a way that not reduced dignity for the person. Bowel control, fluid, food and the possibility to get out for a walk was important. It was also important to have enough time for sharing reflections. Small units gave possibility to personal knowledge.

<p><strong>Bakgrund:</strong> 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. <strong>Syfte:</strong> Att sammanställa och belysa forskning som beskriver hur de anhöriga upplever sin situation av att vårda en anhörig som drabbats av en demenssjukdom. <strong>Metod:</strong> En litteraturöversikt där fem kvantitativa och sex kvalitativa artiklar analyserats. <strong>Resultat:</strong> Artikelanalysen resulterade i tre teman:  <em>en ny livssituation, förändrad relation och känslomässigt påfrestande.</em> I resultatet framkom att anhöriga rapporterade ohälsa. <strong>Diskussion:</strong> 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.</p> / <p><strong>Background:</strong> 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. <strong>Aim:</strong> To collate and illustrate research that describes how the relative experiences their situation of caring for a relative with dementia. <strong>Method:</strong> A literature survey in which five quantitative and six qualitative articles were analyzed. <strong>Results:</strong> Article analysis resulted in three headings: <em>a new life situation, <em>changes in relationships and <em>emotional trying. </em></em></em>The results revealed that caregivers reported illness. <strong>Discussion:</strong> 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.</p>

Diss. (sammanfattning) Jönköping : Hälsohögskolan, 2009. / Härtill 4 uppsatser.

The elderly population (those aged 65 years or older) in Hong Kong is expected to increase from approximately 13% in 2009 to 28% by 2039. With this rapid growth of elders, it raises attention to prevent and treat chronic diseases of aging. Dementia is particularly concerned because the short term memory loss and other cognitive malfunctions lead to a loss of independent function that has a extensive impact on individuals, families, health and social welfare systems. Currently over 70,000 people endure dementia in Hong Kong and expect quadruple rises by 2036. In order to cope with these diseases, accurate diagnosis is very useful, particular at early stage when treatment outcomes are most effective. Numerous studies have found that AD and other dementias could alter brain metabolism significantly. AD patients usually present the posterior cingulated and parietotemporal cortices hypometabolism and spread into the frontal lobes in advanced disease. In contrast, FTD patients show manifestly hypometabolism in the frontal and anterior temporal cortices, while DLB patients present hypometabolism in the posterior brain comprising primarily the parietoocipital regions. Theoretically, 18F-FDG PET scan can help in the early diagnosis of AD and other dementias by highlighting these decreased FDG uptake cortex regions before MRI or CT scans can detect any structural damage. This is a retrospective chart review study. Patients who had received FDG brain PET-CT scan previously had their regional brain metabolism quantitated using a software call Cortex-ID and clinical laboratory tests. The study is * To develop a Neural Network (NN) that can diagnose the various types of dementia using Brain PET-CT scan, testing accuracy of NN versus an expert and, * To see if the NN can correlate with the clinical severity of the disease as reflected by MMSE score. Finally, three neural networks have been designed and they all fulfill all the required specifications. / published_or_final_version / Diagnostic Radiology / Master / Master of Medical Sciences

Retrieval of autobiographical memories (AMs) is important for “sense of self”. Current theoretical understanding of AM retrieval predicts that working memory (WM) and executive functions (ExF) enable the hierarchical search for, and reliving of past, personal events in the mind’s eye. However, there remains a lack of consensus as to the nature of the relationships between these cognitive functions and semantic and episodic aspects of AM. The present study therefore aimed to explore the associations between these variables in a sample with a wide range of ability on measures of WM, ExF, and AM. The study incorporated a between-groups component, and a correlational component with regression and mediation modelling. Participants with Alzheimer’s disease (n = 10) and matched healthy controls (n = 10) were assessed on measures of semantic and episodic AM search and retrieval, auditory and spatial WM, and verbal fluency. AD group AMs were significantly less episodic in nature compared to controls. There were no significant associations between WM measures and hierarchical search of semantic AM, or episodic AM retrieval. Verbal fluency, but not WM, predicted episodic AM retrieval and mediated the effect of dementia status on episodic AM retrieval independent of age effects. The study concluded that people with AD may be limited in their retrieval of episodic AM due to weaker verbal fluency, independent of ageing effects. WM appeared to play little role in facilitating episodic AM retrieval. Reminiscence interventions for people with AD might benefit from incorporating structured, individualised external memory-aids to facilitate more effective AM search and retrieval to prolong wellbeing.

Bakgrund: Idag lever 47,5 miljoner människor med demenssjukdom och den siffran beräknas bli fördubblad var 20e år. Sjukdomen medför stora förändringar i den drabbades och den anhörigas liv och kallas ofta för “De anhörigas sjukdom”. De anhöriga har en viktig roll i den demenssjukes liv, eftersom han eller hon ofta har levt en större del av livet tillsammans med personen med demenssjukdom. Det är därför den anhöriga som känner den drabbade bäst, trots att sjukdomen leder till personlighetsförändringar. Syfte: Att beskriva upplevelser av att leva som anhörig till en person med demenssjukdom (PMD), samt att beskriva hur urvalsgrupperna i de ingående artiklarna ser ut. Metod: En litteraturstudie med deskriptiv design baserad på 12 kvalitativa vetenskapliga artiklar som framkom efter sökningar i databaserna PubMed och CINAHL. Materialet bearbetades och delades in i ämnesrubriker. Huvudresultat: Resultatet visade att anhöriga till PMD ofta upplevde känslor av frustation, oro samt skuldkänslor på grund av bristande information och kommunikation. De anhöriga beskrev också hur de upplevde anpassningen till de förändringar som skett i deras och PMDs liv och på vilka sätt de hanterade förändringarna. Slutsats: De upplevda känslor som framkom i resultatet kom ofta av förlorad kontroll och förändringar som var svåra för de anhöriga att anpassa sig till. Brist på förtroende, dålig kommunikation och otillräcklig information var orsaker till den bristande tilliten. Genom att främja en god relation mellan sjuksköterska och de anhöriga, kan de anhöriga uppleva tillit och trygghet. Det i sin tur kan bidra till att vårdsituationen blir så bra som möjligt för alla inblandade parter. / Background: 47.5 million people live with dementia today, and this number is expected to double every 20 year. This disease causes big changes for the person who suffers and the relative’s life and is often called "The relatives' disease". The relatives have an important role in the dementia sufferer's life, because he or she often has lived a large part of their life with the person with dementia, it is the relatives who know them the best, even though the disease leads to personality changes. Aim: To describe the experiences of living as a relative to a person with dementia (PWD) and to describe the study group in the included articles. Method: A literature study based on twelve qualitative scientific studies that was found through searches in the two databases PubMed and CINAHL. The material was processed and divided into content areas. Main results: The result showed that relatives of PWD often experienced feelings of frustration, anxiety and guilt due to lack of information and communication. They also described how they experienced the adaptation to the changes in their and the PWD lives and the ways in which they managed those changes. Conclusion: The perceived feelings that emerged in the results often came of loss of control and the changes that were difficult for the families to adapt to. Lack of confidence, poor communication and inadequate information were reasons for the lack of trust. By developing a good relationship between the nurse and the families, the families can experience trust and security. That in turn could help the care situations to be as good as possible for all involved parties.

Ο σχηματισμός του αορίστου σε ασθενείς με σημασιολογική άνοια και ήπια γνωσιακή διαταραχή. / Past tense formation in patients with semantic dementia and mild cognitive impairment.

Dementia is a degenerative disease which appears to take away personhood and identity and calls into question how we understand what it means to be a person. My argument is that how people with dementia are seen and imagined is key both to the understanding of their value and the care that is offered. The aim of this study is to determine how the Christian ethos of Methodist Homes (MHA) influences the care of people with dementia in order to develop a general theology of care from within practical theology. The thesis explores the ways in which the Methodist emphases of social justice and prevenient grace offer a basis for dementia care, and how MHA has drawn on its origins within the Methodist Church to develop an ethos of care that places respect for the person with dementia at the centre. This concern for those with dementia is then surveyed and the themes of respect and relationality emerge offering the potential for human becoming. Within MHA the care offered is based on a person-centred model. In order to discover how the Christian ethos of the organisation influences care this thesis explores patterns of delivering care in three homes of each of three types; well-established, recently-acquired and new-build. In each home the views of the staff were surveyed. Three in-depth interviews were conducted when questions were asked in order to understand their perception of the person with dementia. The interviews uncovered what carers regarded as good care and when care did not meet the needs, and why they believed that happened. Browning’s ‘strategic practical theology’ was used to evaluate these findings from within a Christian context to examine the influence of MHA’s ethos on the care offered. The core value chosen as the most important for care was ‘respect’; and while the care offered across all types was ‘person-centred’ the way it was delivered varied. The culture of MHA that gave rise to the values is investigated, along with the challenge of retaining ‘mutuality’ as an ideal as the needs of older people changed. The themes that emerged were those around quality of life and the things that enable the change in thinking from basic ‘caring’ to ‘caring for the person’ as the person is seen in a different way. Dementia is sometimes called the ‘theological disease’, and this understanding of dementia and the person is explored to discern what can be offered from theology to the best ideals of care in order to provide true person-centred care that is respectful of the person. I argue from within practical theology that a new way of seeing the person with dementia is needed in order to anticipate the possibility for human flourishing that is possible in a person, even in dementia. And that, offered with respect, good person-centred dementia-care can be a sign of the Kingdom. Part 1 of the D.Prof. comprises four sections in which I explore dementia from within practical theology; how it impacts on personhood, how I, as a practitioner within Methodist Homes (MHA), could enable others to offer care of the whole person; and how the carers’ understanding of the person makes a difference. In the first section, the literature was surveyed in order to discover the historical development of the term dementia. Until the middle of the twentieth century, there was little care as the condition was not named. But then drugs were discovered that could control unsocial behaviour, and the medical model of care developed. However, a new culture of care developed (person-centred care), because of the better understanding of the social nature of the disease. From within the context of theology, I explored how personhood can be understood within dementia and how, even in dementia, it might be possible to grow into the fullness of Christ as spirituality is enhanced. The second section was in the form of a publishable article which explored how it might be possible to evaluate spiritual care within a dementia-care setting. This took the form of a case study in which I worked with staff in a home that had difficulty evidencing spiritual care. It raised issues about the nature of care and assessment of spiritual care, as well as the rationale behind, and the delivery of, that care. What developed used the biblical concept of ‘fruits of the spirit’ as a way of recognising spiritual dis-ease as it is these qualities which enable inspiration, reverence, awe, meaning and purpose even in those who have no religious beliefs. The model used to offer this care was through the 3 R’s of reflection, relationship and restoration. Section three, reflective-practice section, emerged out of my practice as a chaplaincy adviser for MHA, in which I reflected critically on the contexts and understanding of the manager and chaplain, and how a chaplaincy manual was developed. The ability of the chaplain to work effectively and enable good spiritual care in the home, depended on the relationship between the manager and chaplain. By exploring the culture of both manager and chaplain, a way to enable good communication was discovered. The role of pastoral care and how it is seen within an organisation, that must have a professional management, was investigated and ways suggested for mutual understanding using the chaplaincy manual. The last section examined whether the Christian ethos of MHA encouraged a model of person-centred care. I suggested that a way of making sense of the data is by using types to describe personhood and how that can be made visible by their care. Considering the way that therapeutic interventions (reminiscence therapy, reality orientation, validation therapy, drug therapy) were used offered a way to enable the ethos of the home to be seen more clearly. Central to theological anthropology is the concept of the person which includes an ethical dimension. MHA has the strap line, ‘care informed by Christian concern’, so the study investigated whether this Christian ethos is lived out in the care offered. These aspects of study have led me to begin this thesis to research how care is delivered and what carers understand to be appropriate care. An appreciation of the context in which this care takes place also highlighted a need to conduct a theological exploration of the nature of the person with dementia.

Bakgrund: I en befolkning där medelåldern ökar finns risk för ett ökat antal äldre med demenssjukdom. Demens är ett samlingsnamn för sjukdomar som medför minnessvårigheter och personlighetsförändring, vilket i sin tur kan sänka livskvaliteten. Syfte: var att beskriva aspekter av vad livskvalitet kan vara för personer med demens på särskilt boende. Metod: Detta är en litteraturstudie med deskriptiv design. Nio artiklar som besvarade studiens syfte valdes från databaserna Cinahl och Medline. Resultat: Flera studier rapporterar om vad livskvalitet är enligt demenssjuka som bor i särskilt boende. Livskvalitet är relaterad till bl.a. social samvaro, aktivitet, kost samt fysisk och psykisk känsla av hälsa. Slutsats: Sjuksköterskans omvårdnadsåtgärder kan påverka upplevelsen av livskvalitet för den demenssjuke. Meningsfulla aktiviteter som utförs tillsammans med vårdpersonalen och anhöriga är exempelvis betydelsefulla. Sjuksköterskan bör visa respekt för personens integritet, värdighet, autonomi och delaktighet.