No / The maintenance of self in dementia is associated with socio-biographical factors. The theoretical literature suggests that interpersonal relationships, the social context, and the generation of stories are important in maintenance of self. Empirical research on self in dementia supports this but has been predominantly conducted with participants living in the community. Living in residential care brings additional threats to self. This paper presents a study examining the relevance of a socio-biographical theory of self to people with dementia living in residential care. Between 3 and 8 tape-recorded and transcribed unstructured interviews were conducted with 14 people with dementia who were living in 4 residential homes throughout England and Wales, over a 6-24-month period. They were analysed using an interpretive biographical methodology. The results provide evidence to support the relevance of a socio-biographical theory of self to this group. Relationships with family, other residents and care home staff were important for maintenance of self. Social roles related to work, being part of a family, caring for others and being cared for, were particularly significant for self in this group. The creation of a life story, stories of selected life events, and the telling of stories with possible metaphorical interpretations were also important for the maintenance of self. The results also suggest that psychological and embodied factors may be relevant to the self in dementia. The study suggests that staff working in residential homes should consider these elements if they are to provide care that supports maintenance of self for people with dementia. Implications for future research are discussed.

Made available in DSpace on 2016-04-28T20:38:39Z (GMT). No. of bitstreams: 1 Jose Carlos Zeppellini Junior.pdf: 1218568 bytes, checksum: a068121095255b194e2fabcdd6a6a116 (MD5) Previous issue date: 2013-05-06 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The present doctoral thesis is based on clinical experience and represents a deeper study of the research developed and presented in the master s dissertation Dementia: identities that sicken. Considerations about the psychopathologic aspects of the aging process defended in the Laboratory of Fundamental Psychopathology (Laboratório de Psicopatologia Fundamental), in the Program of Post-Graduation studies in Clinical Psychology at PUC-SP in 2008. The investigation of this work specifically focuses on the peculiarities of the psychic function that directly affects the mnemonic system of elder patients suffering from dementia processes. The point of view hereby defended is that the senile dementia processes are manifestations that are caused by the impossibility of forgetting, resulting in an imprisonment of the memory register. This perspective does not exclude the possibility that other dementia processes, classified as primary, have other forms of expressions and/or distinct genealogies. Nevertheless, it reveals that it is fundamentally important to consider the subjective aspects expressed by the dementia symptomatology. It points out the importance of taking these singularities into consideration in the treatments and demonstrates important aspects of the psychic apparatus concerning the mnemonic functions and the relation with pathos that becomes evident in the psychical working over related to aging (envelhescência). The distress, passion and excess inherent in the aging process send them to the conflicting encounter between the temporality of the body and non-temporality of the unconscious and also, of the ideal of the ego. This encounter may give stimulus to the formation of specific symptoms that will be activated in the senile dementia processes. They will be characterized by the refusal of the present time and the surrender of the ego to the magnificence of the memories from the past, recovered and strengthened by the increasing power of the superego / A presente tese de doutorado constituiu-se com base na experiência clínica e representa um aprofundamento da pesquisa desenvolvida e apresentada na dissertação de mestrado Demências: identidades que adoecem. Considerações sobre os aspectos psicopatológicos do envelhecimento defendida no Laboratório de Psicopatologia Fundamental, do Programa de Estudos Pós-Graduados em Psicologia Clínica da PUC-SP em 2008. O foco de investigação deste trabalho converge especificamente para as peculiaridades do funcionamento psíquico que afetam diretamente o sistema mnêmico de pacientes idosos acometidos por processos demenciais. O ponto de vista aqui defendido é o de que os processos demenciais senis são manifestações que ocorrem em virtude de uma impossibilidade de esquecer, apresentando-se como o resultado de um aprisionamento no registro das lembranças. Essa perspectiva não exclui a possibilidade de que processos demenciais concebidos como primários tenham outras formas de expressão e/ou genealogias distintas. Revela, entretanto, ser de fundamental importância prestar atenção aos aspectos subjetivos expressos por meio da sintomatologia demencial. Aponta para a importância de que essas singularidades sejam levadas em conta nos tratamentos e revela aspectos importantes do aparelho psíquico no que tange às funções mnêmicas e sua relação com o pathos que se evidencia no trabalho de envelhescência. O sofrimento, as paixões e os excessos inerentes ao envelhecimento remetem-nos ao conflitivo encontro entre a temporalidade do corpo com a atemporalidade do inconsciente e, também, do ideal do ego. Esse encontro pode estimular formações de compromissos específicas que serão postas em atividade nos processos demenciais senis. Esses irão caracterizar-se por uma recusa do tempo presente e pela rendição do ego diante da imponência das lembranças, resgatadas e fortalecidas pelo crescente poder exercido pelo superego

The present series of investigations examined the diagnostic accuracy of the Cognitive Examination (CAMCOG) from the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) in the differential diagnosis of various dementing conditions. Specifically, this study examined: (a) the degree to which the CAMCOG would differentiate normal individuals from patients with Alzheimer's Disease (AD) and from those suffering from non-AD dementing conditions, (b) the extent to which the CAMCOG would distinguish between patients suffering from organic dementing conditions, those having functional psychiatric disorders, and normal persons, and (c) whether the CAMCOG would offer an improvement in diagnostic accuracy over a widely used screening instrument (i.e., the Mini-Mental Status Examination, MMSE) when attempting to differentially diagnose dementing patients and normal cohorts.A review of the literature was presented with an emphasis on the difficulties in establishing differential diagnosis, inaccuracies in diagnosis, the importance of improved diagnostic accuracy, and the use of neuropsychological measures in the assessment and diagnosis of patients suffering from dementing illnesses. Further, research relevant to ancillary diagnostic techniques, the various neuropsychologicalapproaches used in evaluating and diagnosing mental disorders in the elderly, and studies investigating the utility of specific cognitive/neuropsychological measures in the differential diagnosis of dementing diseases was presented.The results of these investigations revealed that the CAMCOG provides excellent diagnostic sensitivity and specificity when differentiating normal persons from clinically diagnosed AD patients and when distinguishing between individuals with an organic-dementing condition and normal adults. The CAMCOG was found to be less effective in differentiating AD and non-AD dementia patients and in distinguishing between patients suffering from organic dementia versus specified psychiatric disorders. Finally, the CAMCOG demonstrated a slight improvement in diagnostic accuracy over the Mini-Mental Status Examination. These results were discussed in terms of their support for the utility of the CAMCOG as an excellent screening measure when used to differentiate patients suffering from various dementia-producing disease states and normal persons. / Department of Educational Psychology

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

No description available.

It was hypothesized that 192 IgG-saporin lesions of the basal forebrain cholinergic system (BFCS) would disrupt differential reinforcement of low rate (DRL) learning in an uncued DRL task, but would not impair acquisition and performance in the cued version of the task. Results suggest that BFCS lesions impair vigilance to the external cues despite continued practice in the cued DRL, whereas continuous attention to internally produced cues recovers with extended practice in the uncued DRL.

The purpose of the study was to develop a behavioral nursing intervention strategy for specific deficits in grooming performance of elders with dementia. A quasi-experimental two-group design using switching replications with removed intervention was employed. Three residents with severe cognitive impairments and three residents with mild cognitive impairments were chosen from a special dementia care unit of a long-term care facility. Three residents among six residents were randomly selected to receive the behavioral intervention early. Baseline and post-intervention assistance was provided by nurse aides. Each resident was asked to wash hands, brush teeth, wash face, and comb hair in a sequence. Ten intervention sessions were conducted by the trained intervener for two consecutive weeks. The intervention consisted systematic prompting and social reinforcement. A total of 21 sessions were collected in the morning using videotape recordings. Interobserver agreement for the instruments designed by the investigator was measured by the trained observers. Data were analyzed in two phases. First, the quantitative data were analyzed to determine the independent functional behaviors of individuals, and the change in the intensity of nursing effort associated with grooming of elders with dementia. Data were examined by individual graphic display throughout the three phases (baseline, nursing intervention, post-intervention). Second, the qualitative data were analyzed to determine the antecedents, consequences, and resident responses associated with grooming, the caregiver problem behaviors, and resident problem behaviors associated with grooming performance. The results show that the functional behaviors of even severely demented elders can be promoted, indicating the effectiveness of nursing care strategies on the ADL task of grooming. The data in this research suggest that maintaining or improving functional ability is possible with a behavioral nursing intervention, which was a highly structured and systematic approach that involved modifying the environmental and behavioral context, through strategies such as prompting and social reinforcement, when necessary. Furthermore, through the qualitative analysis, the functional relationships between antecedents, consequences, and behaviors of demented elders allowed the investigator to analyze the caregiver problem behaviors and resident behavior problems associated with grooming.

No / Starting from the premise that people are essentially narrative beings, I argue that the onset of severe mental illness compromises the narrative enterprise of being able to construct one's Self and one's relationships inmeaningful and coherent ways. This is due to both the curtailment of opportunities for narrative engagement and the dispossession of those whose narratives do not conform to the current conceptualization of narrative and narrativity. In these circumstances, supporting the narrative enterprise is an ethical endeavour that requires that we examine not only which narratives we construct, but also how we construct them. This requires a re-thinking of what might constitute narrative and how we might facilitate or enhance the narrativity of people with severe mental illness. Following this, I suggest four means to support the narrativity of people with severe mental illness: through maintaining narrative continuity, maintaining narrative agency, countering master narratives and attention to small stories.

台灣在過去的數十年內，罹患失智症人口逐漸增多，其中的多數皆有接受了各層面的照護，舉凡藥物治療、醫護治療、復健治療以及職能治療，然其中的成效與需求之研究仍相當缺乏。故本研究採以質性與量性研究方法，以便於探索目前失智症患者家屬照護時所面臨的實際抉擇歷程與主要需求，並同時探索個案醫院內的治療效果與病患入院時狀況之關係，本研究希望藉由中部地區失智症病患照護的需求及機構之供給的角度來探索研究所能增進其醫療服務品質之處。 在質性研究方法部分，本研究以民族誌決策樹研究法來洞悉與探索家屬在面臨照護失智症病患時是否要採行機構式照護的決策歷程以及決策條件。藉由深度訪談結果粹取出的判斷準則發現，影響家屬決策之最主要考量為失智症病患者的失智程度，其餘包含道德規範、照護負擔、病患是否需要騎他的專業醫療照護以及照護中心的軟硬體環境。本研究整合考量這些判斷準則的優先順序、輕重緩急以及因果關係後將之建立決策樹，並以另外五十名家屬驗證該模型之預測力，得到預測準確率為92%。 此外，本研究再以量性方法來探索治療對於不同失智症病患的成效。結果顯示入住時狀況較好的失智症住民會以更積極的態度來接受職能治療，也因此他們擁有較大的改善或控制病情的機會，然而當住民以消極的態度接受職能治療時，則其治療效果遠不及積極治療者，也因此病情退步的機會較大，主要原因在於多數情況較差的住民具有攻擊、抗拒治療的傾向，使得照護工作變得更為艱鉅，故本研究建議家屬應重視職能治療以及與病人互動之重要性，不論是在居家照護亦或是機構式照護 / Over the past decade, the number of long-term care (LTC) residents has increased, and many have accepted treatments such as medication, rehabilitation and occupational therapy. This study employs both qualitative and quantitative techniques in order to discuss senile dementia patient care in long-term care institutions, and we use a supply and demand viewpoint to explore what services are really necessary for the patient and their family. In qualitative method, the main purpose of this stage is to use the ethnographic decision tree model to understand and explore the decision criteria of the subject. Our study found that the degree of dementia of the patient always affects the decisions made by family members – in fact, this is the most important of all criteria elicited from the interviews with family members. There are also ethical constraints, care burden, norm of filial obligation, patient need professional medical care and institutional environment, etc. which mentioned by families. We linked together the decision criteria considered most important in accounting for the decision-making sequence of family members to be the ethnographic decision tree model which predictive power is 92%. In quantitative stage, our study discussed the effectiveness of occupational therapy when given to dementia patients of different contexts. The results of this stage showed that patients of a good condition in the first stage present a more positive attitude towards participation in the occupational therapy designed by the institution; therefore, they have a greater chance of their condition improving or remaining the same. However, patients of an average condition have a more passive attitude towards taking part in any therapy; therefore, they have a greater chance of their condition deteriorating, because of their violent tendencies and their resistance to care, the task of caring for these patients is more difficult than caring for patients in the other groups. Above all, we suggest that families adopt the therapies no matter in homecare or institutionalization, as early as possible in order to improve the likelihood of being able to control the patient’s condition. It is understandable that accepting more therapies and interaction in the early stage of dementia, having higher chance to go well, however, by waiting until then they also miss the best opportunity to attempt to improve the patient’s condition, it is really not the good way we suggest to be.