This study examines the question of whether it is possible to enter into a psychotherapeutic relationship with a person diagnosed with Dementia. A preliminary study focusing on providing short term psychotherapy to a man diagnosed with severe dementia provided the opportunity to develop the case study approach used in this study, where the research design was constructed around an account of weekly meetings over 3 years. The term ‘dementia’ is explored, along with the current treatments that are available and psychotherapy is considered in relation to them. Research is presented suggesting that education and learning may have an inhibitory effect on the onset and progression of dementia; psychotherapy is considered as a form of therapeutic education. The approach to the psychotherapy used in this study is explored, acknowledging the point that Freud highlighted with reference to psychoanalysis where he considered the technique to be individualised to each analyst rather than a generalised process. The therapist’s orientation is examined by referring to the theory that has been instrumental in formulating his approach to psychotherapy which includes existential, psychoanalytic and post-modern theoretical perspectives on practice in relation to a person with dementia. From this exploration, an approach based on the philosophy of Emmanuel Levinas emerges as the predominant influence in this study. The preliminary study highlighted the difficulties in using case study as a means of generating psychotherapeutic knowledge, especially in relation to scientific methods of research. The researcher examined a range of epistemological ideas, including aspects of the work of Plato, Aristotle, Kant Heidegger, in order to identify a basis for developing approach to researching psychotherapy using case study. A method emerged in the form of a psychotherapeutic case presentation from the therapist’s perspective utilising a phenomenological-hermeneutic approach. This approach is concerned with producing ‘meaning’s in relation to an observation rather than being preoccupied with producing ‘the’ specific meaning. The case study is presented as an illustration of an account of a series of meetings between a trainee psychotherapist and a person diagnosed with dementia, whereby the researcher and the reader can address the issue of ‘possibility’ raised by the research question. The findings of this study identify a difficulty for the therapist in this relationship to overcome preconceptions associated with the diagnosis of dementia. The account of therapy also shows how the therapist appears to be representative of other significant relationships for this person and acknowledges what Levinas calls the non-intentional which refers to glimpses of the other that allow a recognition of separation and ‘otherness’ that is not concerned with ‘knowing’. The findings were also found to have significant implications for the use of intentional research and the potential influence that it can have on what is being observed by excluding the non-intentional. The association of theory with internationality is identified in the findings and the possible impact on the practice of psychotherapy noted, particularly in relation to the prohibition of the non-intentional. The study concludes that the question of ‘whether psychotherapy is possible’ might be asked of anyone entering therapy. The diagnosis of dementia can have the effect of excluding a person from a relationship with another, and in these circumstances, it becomes difficult to offer psychotherapy.

Although people with hyperphagia show significantly more patterns of stereotyped behaviour than matched demented controls the prolonged period of eating does not seem to be due to a stereotypy but to a delay in the satiation mechanism. Hyperphagia typically occurs in the middle stages of the dementing illness and lasts for a mean of about three years. These studies demonstrated that subjects with dementia who are hyperphagic have a major disturbance in the mechanisms controlling satiation, hunger, food choice and satiety.

Denna uppsats har till syfte att ta reda på vilken funktion vårdpersonal respektive anhöriga till demenssjuka anser att tv-tittande har för demenssjuka som vårdas på demensboende. Uppsatsen bygger på följande frågeställningar: hur beskriver de båda kategorierna av intervjupersoner funktionen av tv-tittande, utifrån sin profession respektive sina upplevelser? Hur förhåller sig den valda teoretiska modellen, uses & gratifications, till tv-tittande på demensboenden? Undersökningen har en kvalitativ ansats och genomfördes med hjälp av intervjuer. Fyra personer som arbetar i ledande befattning för vårdpersonal vid demensboenden intervjuades samt fyra anhöriga till demenssjuka. Demensboendena är belägna i fyra olika kommuner – två i Uppsala län och två i Stockholms län. Undersökningens resultat visar att vårdpersonalen anser tv:ns funktion vara att sprida glädje genom humoristiska filmer och att stimulera fram samtalsämnen när personal och demenssjuka tittar på gamla filmer tillsammans. Samtidigt betecknar vårdpersonalen tv-program som en potentiell framkallare av oro bland de demenssjuka och att det är viktigt att begränsa mängden tv-tittande på demensboendena. De anhörigas svar kring tv-tittandets funktion är mer vag och obestämbar. Detta kan bero på att demensboendena i fråga inte informerat de anhöriga tillräckligt om hur personalen använder sig av tv för att uppmuntra de boende till igenkänning och skratt med humoristiska tv-programs hjälp. När det gäller uses & gratifications-modellens tillämpning på tv-tittande på demensboenden, måste den modifieras i betydande delar för att korrekt kunna återge hur medieinnehåll på demensboenden ser ut. Glädje – gärna via tv:s förmedling. Oro – den kan blossa upp framför tv:n, men är oönskad. Därmed kan tv:n på demensboenden betecknas som ”ett tveeggat svärd” – eller kanske snarare – en tveeggad skärm. / This thesis had as purpose to find out what function is ascribed to watching television in dementia care facilities, by dementia personnel and family members of persons with dementia being taken care of in these facilities. The thesis is based upon the following questions: how do the both interviewee categories describe the function of watching television, from their professional point of view and their personal experience? How does the chosen theoretical model, uses & gratifications, relate to watching television in dementia care facilities? The study is based on qualitative interviews. Four people who work in leading position of nursing staff at dementia care facilities were interviewed, as well as four people who are family members of persons with dementia. The dementia care facilities are located in four different Swedish municipalities – two in the county of Uppsala and two in the county of Stockholm. The main results show that the nursing staff interviewees consider the function of television to be spreading joy through funny movies and to suggest topics of conversation, as nursing staff members and the dementia patients watch old movies together. Simultaneously, the nursing staff interviewees consider television programs as a potential anxiety provoker, and they believe that the time spent watching television in the facilities should be limited. The replies from the family interviewees on the function of watching television are more vague and indeterminable. This may stem from a lack of information from the care facilities towards the family members regarding the use of television as an encouragement of laughter with funny television programs as aid. Regarding the applicability of the uses & gratifications model for description of watching television in dementia care facilities, the model has to be modified considerably, in order to correctly be able to represent how media content at these care facilities is dealt with. Joy – more than gladly through the conveyance of television. Anxiety – it might very well pop up in front of the television set, but it is unwanted. Hence television in dementia care facilities may be considered as “a double-edged sword” – or perhaps rather – a double-edged screen.

This study set out to evaluate a small scale model of care for people with dementia that aimed to support residents within a daily household routine (termed household care). Stemming from a pluralistic evaluation, this thesis examines issues identified as important to residents' experience, namely the ability of the care houses to provide a home for life, the process and effectiveness of recreating a homely environment and the implications of group-living. Three case studies were investigated with multiple methods, including semi-structured interviews with staff, relatives and representatives of managing agencies, structured observation and assessment of dependency. Respondents believed care housing was superior to its alternatives and attributed perceived improvements in residents' well-being to the nature of staff support and the 'homely' setting. Agency representatives were preoccupied with their relationships with each other and how to sustain and expand this model of care. Staff focused on the nature and conditions of the work. Kin were keen that residents should settle and stay in the care houses. Residents' support needs at least matched entry criteria but over half had to move out to hospital because of physical illness and behavioural problems. This study suggests that it was very difficult for residents to accept the houses as 'home'. Residents' and their relatives' participation was, in practice, limited but one house was particularly successful in implementing household care; reasons are suggested for this. Residents' interactions with each other seemed to be increased by household care but their relationships were influenced by a number of factors, including the presence of dementia. The latter exacerbated the tensions of group-living. The challenge for care houses was to sustain care as dementia progressed and extend good quality care to those with more substantial behavioural and physical support needs.

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.

No description available.

Thesis (MPsy(Clinical))--University of South Australia, 2001

The prevalence of chronic pain is known to increase with advancing age, with over 50% of community dwelling older adults (aged 65 years and over) and up to 80% of those residing in nursing homes estimated to be suffering some form of persistent or recurring pain complaint. In addition to a greater likelihood of pain, advancing age is associated with increased reports of pain interference. It is possible to ascribe age-related changes in pain report and impact to increased disease prevalence and severity in older people. However, there is also evidence that ageing has effects on pain perception, central pain processing, and plasticity of pain responses that are not explained by co-morbid disease. / The increased prevalence of chronic pain in older adults represents a major public health concern. As a result of increased life expectancy and the post-World War II baby boom, there will be a dramatic change in the demographic structure of our population over the coming decades, with older adults representing the fastest-growing segment of our communities. The proportion of the total population over the age of 65 in Australia has risen from 9% in 1976, to 12% in 2001, and is predicted to reach 16% by the year 2016. Pain that is undetected or under-treated can adversely affect quality of life for older adults, leading to diminished mood, impaired cognition, behavioural problems, as well as increased functional dependence. This in turn contributes to greater demands for daily personal care and a resultant increase in health-care costs. / Pain management is a particularly salient issue in the case of older adults with dementia, who are at increased risk of undetected pain on account of impaired cognition and communication skills. Indeed, clinical reports show that patients with Alzheimer’s disease (AD) are routinely administered fewer pain-relief medications compared with their cognitively-intact peers. Understandably, reports of reduced analgesia in AD have sparked considerable research interest, and over recent years there has been a marked increase in the number of studies aimed at better characterising the experience of pain in patients with AD. However, despite these efforts, the effects of neurodegeneration on pain processing, and the specific ways in which the disease process impacts on brain responses to noxious stimulation and the ensuing experience of pain have not been previously determined. / Improved management of pain is fundamental to the clinical care of older adults, particularly those with dementia. However, the potential to adequately counteract pro-nociceptive processes and facilitate endogenous inhibitory mechanisms in the treatment of ongoing pain in older adults will only become possible once the effects of ageing and age-related neurodegeneration on central pain processing are identified and described. The overarching goal of this thesis was therefore to improve current understanding of the ways in which normal ageing and Alzheimer’s disease impact on the perception and central nervous system processing of pain. The findings of this thesis provide valuable new insights into the impact of ageing and AD on the central mechanisms contributing to pain perception, and may therefore contribute toward better management and treatment of pain in this vulnerable and rapidly growing sector of our community. / Thesis outline: Chapter 2 provides a review of the background literature and rationale for the thesis. The chapter begins with a discussion of current understanding of pain as a multidimensional phenomenon shaped by sensory, emotional and cognitive components, and leads into a description of neural mechanisms of nociception, as well as the supraspinal processes involved in the elaboration of nociceptive signals into these aspects of pain. The impact of ageing on the structure and function of central nervous system regions underlying these processes are discussed, along with the findings from previous clinical and empirical data which suggest age-related changes in pain perception. Current understanding of the neuropathological and clinical aspects of AD is reviewed, with particular emphasis on potential ways in which the disease may impact on central nociceptive processing and the behavioural response to pain. This is followed by a review of the previous clinical and empirical literature examining pain perception in AD. Finally, the aims of the current thesis are outlined. / Chapter 3 describes the general methods which were employed in the subsequent empirical chapters in order to address the aims of the thesis. The equipment and psychophysical procedures used to assess pain perception in healthy young and older adults and patients with AD are described. The basic principals of magnetic resonance imaging (MRI) are then outlined, and the utility of structural and functional MRI for assessing age-related and disease-related changes to brain regions involved in pain perception and processing are discussed. The empirical studies which were undertaken to identify the impact of ageing and AD on central pain processing are presented in the next three chapters. / Chapter 4 begins with psychophysical studies comparing sensory and emotional responses to pain in healthy young and older adults, and follows with MRI investigations of age-related differences in brain volumetry and pain-related brain activity. Studies of pain sensitivity and pain-evoked brain activity in patients with AD compared with age-matched controls are presented in Chapter 5. Following on from these findings of AD-related differences in pain-evoked brain activation, the study described in Chapter 6 used functional connectivity analysis in order to assess the impact of AD on the functional integration of brain regions underlying the sensory, emotional, and cognitive aspects of pain. / The key findings presented in the preceding three chapters are summarized in a general discussion in Chapter 7. The implications of the findings, in terms of the clinical management of pain in older adults with and without Alzheimer’s disease are discussed. The opportunity is also taken to discuss some of the limitations of the present research, and finally, recommendations are made for future research directions.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--Cornell University, August, 2008. / Vita. Includes bibliographical references (leaves 126-141).