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Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Dementia is a chronic illness characterised by the progressive deterioration of cognitive functions. Patients diagnosed with dementia are most often cared for by family members. Families caring for dementia patients are faced with tasks that are physically exhausting and psychologically distressing. Nevertheless, some families show resilience and are able to overcome the adversity of the illness. This study aimed to identify and explore the resilience factors these families utilised to rise above the hardships faced when caring for a demented family member. The study was based on McCubbin and McCubbin’s (1996) Family Resiliency Model of Family Stress, Adjustment and Adaptation and Walsh’s (2002, 2003) Family Resilience Framework. A mixed-methods approach was followed to collect data from a convenience sample drawn from the Cape Metropolitan area in the Western Cape, South Africa. The study sample comprised of families in which either a spouse (n = 44) was caring for a partner with dementia or adult children (n = 47) were caring for a parent with dementia. The family resilience factors of these subgroups were explored separately and were compared with each other. The quantitative data analysis was conducted using analyses of variance (ANOVA), Pearson’s product-moment correlation coefficients, and a best-subsets multiple regression analysis. Qualitative data were analysed using thematic content analysis. These analyses revealed that positive communication patterns, acceptance, optimism, family hardiness, family connectedness, and the effective management of symptoms facilitated family adaptation in both the spouse and child subgroups. Negative patterns of communication within the family was the only variable that was inversely related to family adaptation in both family subgroups. The level of adaptation in the different family subgroups did not differ significantly, but the subgroups did differ slightly in terms of their communication patterns, coping strategies and social support avenues utilised. In addition to expanding the current literature regarding family resilience, the body of information collected in this study could be used to help families caring for dementia patients to create a family environment that maximises adjustment and adaptation. The results could also be used in the development and evaluation of intervention programmes tailored to the needs of these family subgroups. / AFRIKAANSE OPSOMMING: Demensie is 'n chroniese siekte wat gekenmerk word deur die progressiewe agteruitgang van kognitiewe funksies. Pasiënte wat met demensie gediagnoseer word, word meestal deur familielede versorg. Gesinne wat sorg vir demensiepasiënte word gekonfronteer met take wat fisies uitputtend en sielkundig ontstellend is. Tog toon sommige families volharding en is hulle in staat is om die teëspoed van hierdie siekte te oorkom. Hierdie studie het gepoog om die veerkragtigheidsfaktore te identifiseer en verken wat deur families wat 'n familielid met demensie versorg, aangewend word om bo hulle omstandighede uit te styg. Die studie is gebaseer op McCubbin en McCubbin (1996) se Family Resiliency Model of Family Stress, Adjustment and Adaptation en Walsh (2002, 2003) se Family Resilience Framework. Beide kwalitatiewe en kwantitatiewe data-insamelingsmetodes is in hierdie studie gebruik. 'n Gerieflikheidsteekproef is uit die Kaapse Metropolitaanse gebied in die Wes-Kaap, Suid- Afrika gewerf en het bestaan uit gesinne waarvan eggenote (n = 44) vir hulle eggenoot met demensie sorg of volwasse kinders (n = 47) vir ’n ouer met demensie sorg. Die gesinsveerkragtigheidsfaktore van hierdie subgroepe is afsonderlik ondersoek en met mekaar vergelyk. Die kwantitatiewe data-analise is via variansieontleding (VARO), die berekening van Pearson se produkmoment-korrelasiekoëffisiënte, en beste-subset regressie-analises uitgevoer. Kwalitatiewe data is met behulp van tematiese inhoudanalise ontleed. Hierdie analises het getoon dat positiewe kommunikasiepatrone, aanvaarding van die situasie, optimisme, familie gehardheid, familie verbondenheid, en die doeltreffende bestuur van demensiesimptome familie aanpassing in beide die eggenoot- en kind-subgroepe gefasiliteer het. Negatiewe, opruiende kommunikasiepatrone binne die gesin was die enigste veranderlike wat in beide subgroepe 'n omgekeerde verwantskap met familie aanpassing gehad het. Die vlak van aanpassing in die verskillende familie subgroepe het nie beduidend verskil nie, maar die subgroepe het effens verskil in terme van hulle kommunikasiepatrone, streshanteringstrategieë, en bronne van sosiale ondersteuning. Die resultate van hierdie studie brei uit op die huidige literatuur oor gesinsveerkragtigheid en kan gebruik word om families wat vir demensiepasiënte sorg te help om 'n familie-omgewing te skep wat die gesin se aanpasbaarheid verbeter. Die resultate kan ook gebruik word in die ontwikkeling en evaluering van intervensieprogramme wat die behoeftes van hierdie subgroepe teiken.

It is necessary to assess the intellectual functioning of dementia patients. However, psychometric instruments such as the Wechsler Adult Intelligence Scale - revised (WAIS-R) are often too demanding for dementia patients, precluding its utility. Clinicians and researchers have indirectly estimated a dementia patient's IQ from the Mini-Mental State Examination (MMSE). This measure is an eleven item screen instrument of global cognitive functioning. Fairly accurate estimates of IQ have been predicted using the MMSE total score.The purpose of the present study was to determine if it is possible to more accurately predict intellectual functioning when the individual MMSE items were used to predict Full Scale, Verbal, and Performance IQ using multiple regression analyses. Forty elderly dementia patients were administered both the MMSE and the WAIS-R. The MMSE total score was entered into a simple linear regression to predict FSIQ. In addition, the eleven item scores of the MMSE were entered into separate stepwise regressions to predict FSIQ, VIQ, and PIQ. The increment in the amount of variance accounted for in the FSIQ between the simple and multiple regression equations were evaluated for statistical significance.The results of these investigations revealed that while the multiple regression equations using MMSE item scores predicted a significant amount of the variance in IQ, they were not statistically superior to using the MMSE total score alone. The MMSE total score was found to account for 76.2% of the variance in Full Scale IQ. The MMSE items that were found to add significantly to the variance in intellectual level accounted for 80.9 %, 75.1 %, and 73.4 % of FSIQ, VIQ, and PIQ respectively. The results of the present study replicated other research that found the MMSE total score to accurately predict intellectual functioning in dementia patients. / Department of Counseling Psychology and Guidance Services

As there were few studies of older husbands’ experiences associated with providing care at home for spouses with dementia, the researcher designed a two-stage study to examine their experiences, In stage one, a qualitative paradigm guided one-to-one interviews with sixteen care giver husbands to examine their care giving experiences. Analysis of the interview data guided the identification of four models of care giving related to the past, present and future and an overall model over time. In stage two, a comprehensive questionnaire was developed and questionnaire items were identified from multiple sources. In stage two the researcher utilized a quantitative approach to identify to investigate husbands’ experiences. A representative sample of 71 care giver husbands participated by completing the questionnaire and standardized measures of burden and depression along with other measures of husbands’ characteristics and experiences and levels of wives’ illness and associated behaviour. Predictive models of care giver burden were care giving seen as a ‘job’, effects of care giving on the husband-wife relationship, and use of avoidant-evasive coping strategies by husbands. The best predictive models of care giver depression were use of avoidant-evasive coping strategies and changes in husbands’ emotional health status related to care giving. / Doctor Of Philsophy (PhD)

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A sample of 22 persons who care for relatives exhibiting initial symptoms of senile dementia were administered paper-and- pencil questionnaires to determine their level of subjective burden and psychological symptomatology. Each participant's attributional style was measured on an internal-external dimension, and their causal attributions regarding their relative's symptomatic behaviors were assessed. Results indicated that attributional style did not predict specific attributions about illness-related behaviors, but the tendency to not blame an afflicted relative for their behavior was predictive of subjective burden and symptoms of depression and anxiety. Subjective burden was found to predict feelings of hostility in caregivers.

This dissertation is a qualitative study of six daughter-caregivers' narratives of their experiences in caring for their mothers who were afflicted with a progressive dementia such as Alzheimer's disease. Many correlational and experimental studies have attempted to show whether humor can be utilized to reduce stress, or promote wellbeing. Results are mixed. This outcome is due in part to the ways different kinds of humor may function in different circumstances for different individuals. Few studies have analyzed directly how humor may function in circumstances where it is generated in a natural context that is potentially threatening to highly relevant personal values. The family caregiving context provides a setting for generating narratives about how individuals cope with such circumstances. This study analyzes six caregiver narratives in terms of personal problem-solving processes and emotion regulation under conditions of chronic stress. This study addresses how caregiver-humor may function in this context. These caregivers exhibited and reported a variety of non-humorous coping strategies such as problem-solving to change aspects of the situation where appropriate. They evaluated and changed thoughts, feelings, and attitudes to develop new meaning, to find benefits, and to develop more integrated frames of reference for meeting caregiving challenges. Caregiver humor was embedded in this natural problem-solving process. This study extends support for the contentions from prior research and theory that humor can, under certain conditions, support stress relief and the development of attitudes that are conducive to promoting increased well-being in situations that seriously challenge or threaten valued outcomes. The personal experience narratives of these participants provide evidence that supports many humor theories and extends the range of their application. Participants utilized humor in ways that confront and to some extent resolve the incongruities of caregiving by regulating emotion and motivation, and by celebrating mastery and adaptation to life's challenges. The data support the proposition that, specifically, humor may diminish the impact of negative affect, and boost the motive power of positive affect in problem-solving processes. / text

This thesis explores and explains the development of day care for people with dementia in Kerala, India. The development process is framed within the context of social globalisation. The central aim of the thesis is to further build theory on how and why social policy from one context is transferred and utilised in the development of social policy in another. The theoretical constructs of policy transfer and policy translation are used to explore the development process. Policy transfer is an existing concept within policy and politics literature. Theory on the concept of policy translation is built up within the thesis using theories of literary translation. Exploration of these processes provides an explanation of the development of day care. Policy transfer and policy translation are found to take place between the UK and Kerala. Policy ideas and information from the UK are transferred and then used within the implementation of day care in Kerala. A two-part research design explores firstly policy transfer and then policy translation. Policy transfer is examined within an analytical framework developed from existing models of policy transfer. Policy translation is investigated through a comparative analysis of day care for people with dementia between the UK and Kerala. The differences between day care in the two contexts represent the changes caused by the processes of policy transfer and policy translation. The main findings of the thesis are that policy transfer and policy translation have taken place within the development of day care in Kerala. The two concepts are found to complement each other. The theoretical construct of policy translation provides additional detail and clarity on the process of policy development to that provided by policy transfer. Policy transfer and policy translation can be described as mechanisms by which social globalisation is taking place and in turn globalisation promotes these processes. The thesis concludes that the theoretical constructs of policy transfer and policy translation as developed here could be used within other research to explore the processes of globalisation.

Individuals are living longer now than they have in the past. As a result, there is an increased incidence in illnesses that are more prevalent in later life. One group of illnesses that is more prevalent is age related dementia. Alzheimer's disease (AD) and vascular dementia (VaD) are two common types of dementia found in the older adult population. Recent research suggests that these two types of dementia may both have a vascular component that is instrumental in their development. Not only may this vascular component be present in both these illnesses, but also it may be related to a more severe cognitive decline in the aging process. Results indicate that both cardiovascular disease and general and spousal social support in middle age are all three independent significant predictors of mild cognitive impairment and other non-normative cognitive impairment in later life. However, results do not indicate that social support moderates the relationship between cardiovascular disease and cognition.

This study is a mixed-method study that seeks to develop a set of institutional dementia care indicators to evaluate quality of care and inform the improvement of quality of life (QOL) for Taiwanese people with dementia living in care homes. It also uses comparative analysis to compare the different features of policy and its delivery in dementia care between Scotland and Taiwan, a comparison designed to aid the development of dementia care policy, and the establishment of quality indicators for institutional dementia care, in Taiwan. This study employed the person-centred care approach at the micro perspective, and the total quality management (TQM) approach at the macro perspective, in order to inform a seamless care model for people with dementia living in care homes. Data were collected in two stages: comments from experts in dementia care were recorded in an exercise using “Delphi” methodology; subsequently the opinions of service receivers were recorded in a fieldwork exercise. The Delphi exercise (stage one) acted as the pre-test, involving 24 experts in dementia care in Scotland and Taiwan in evaluating the usefulness and applicability of proposed quality indicators for institutional dementia care. Quantitative and qualitative data from the Delphi panel were analyzed. The fieldwork (stage two) collected 237 questionnaires (from 122 residents with dementia and 115 family members) in 14 Taiwanese care homes for people with dementia (including special care units within care homes). The field test data were analyzed using reliability and item analysis, confirmatory factor analysis (CFA), and descriptive and inferential statistics. Initially, 43 proposed quality indicators for institutional dementia care were identified through literature review. However, after two Delphi rounds, only six key dimensions (41 quality indicators) were identified by consensus as the important items for use in measurement of quality of care for people with dementia living in Taiwanese care homes. Through reliability and item analysis, and CFA, this research developed a model which is a three-factor structure (social care, health and personal care, and environment) with 18 quality indicators. The 18 quality indicators have high reliability, validity, and credibility and load onto a second order factor which represents quality of care for people with dementia living in care homes. Further analysis was then conducted to explore how relative ratings on these three factors differed according to measured characteristics of the residents and their family members. In general, only a few strong patterns of difference emerged and multiple linear regression analysis suggested that differences in ratings could not be attributed to influences of socio-economic and socio-demographic differences between respondents. The study concludes that the Delphi method could be used as a methodology for health services research to integrate the opinions of multidisciplinary dementia experts and that CFA is an effective technique to study the empirical factor structure. The findings suggest that the 18 quality indicators could be suitable criteria for people with dementia and their family members to evaluate care quality and select an appropriate care home. The indicators also have important policy implications for the Taiwanese Government and regulations intended to ensure that care homes meet the requirements of service receivers.