Dissertations / Theses on the topic 'Senile dementia – Patients – Family relationships'

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.

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.

Caring for a family member or loved one with dementia places a heavy burden on those providing the care. Caregivers often develop chronic depression because of having to deal with this burden. A great deal of literature has been published discussing coping effectiveness, effects of social support, and other internal and external means of support for the caregiver. However, little has been written about the changes, if any, in depression that the caregiver experiences after the termination of care, either through institutionalization or death of the person with dementia. This study examined whether there is a change in depression of spousal caregivers after institutionalization of the dementia care recipient as well as any changes in depression that may have occurred as a result of the death of the dementia care recipient. Two theoretical models, the wear and tear model and the adaptation model were discussed in terms of caregiver depression after institutionalization of the dementia care recipient. Two other theoretical models, the relief model and the stress model, were discussed in terms of caregiver depression after the death of the dementia care recipient. Datasets from the National Institute on Aging sponsored Health and Retirement Study were analyzed. Results indicate that both male and female spousal caregivers report an increase in depression after the institutionalization or death of the dementia care recipient, but that as time passes, males report a decrease in depression while females continue to report an increase in depression.

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 research examines narratives about the quality of everyday life with dementia. The aim of the study is to compare and contrast differing perspectives about the impact of ageing and dementia upon the lives of older people with dementia. A total of 50 interviews with six older people with dementia and ten family and paid carers were conducted over a two-year period. Narrative analysis was used to examine the content and structure of their accounts to understand their perspectives on what matters most to people living with dementia. This in-depth analysis enabled an exploration of different social concepts and narrative constructions that people draw upon in making sense of their experiences of caring and living with dementia. The analysis demonstrated that older people incorporate ageing and dementia into a continuing sense of self. Positive constructions of living with dementia involve the ability to lead a meaningful life that supports pre-existing social roles and relationships and active engagement within the family and community. The emphasis is on living an ordinary life while responding to the challenges associated with cognitive impairment and social stigma. For family and paid carers, perceptions of a meaningful life depend on how the identity of the older person with dementia is positioned relative to past social roles and relationships. Positive constructions assume continuity as opposed to focusing on disruption in the person’s identity and life. Carer perspectives are also influenced by how the person is perceived to conform to social standards of normality. The narratives of older people with dementia reflect their active struggle to find meaning in terms of realising their sense of self within a social world that largely defines them as different and out of the ordinary. The narratives of carers resonate with emotional difficulty, reflecting their struggle to make sense of a life that is not represented as essentially normal. These findings show that, for all, finding meaning in everyday life depends upon making sense of that life as normal and ordinary.

碩士
長庚大學
護理學研究所
94
The purpose of this study was to explore the relationships between mutuality and role strain from caregiving activities in family caregivers of patients with dementia. This study used the cross-sectional design with purposive sampling. One hundred and twenty elderly persons with dementia and their family caregivers from the “memory clinics” at a medical center in the northern Taiwan participated in this study. Instruments were structured questionnaire including the Mutuality and the Role Strain from Caregiving Activities Scale, both developed by Archbold. The results indicated that mutuality and role strain from caregiving activities were below mild to moderate. Those family caregivers with children under age eighteen in household, and caregivers being daughter-in-law reported a worse mutuality. The predictors of role strain from caregiving activities, including mutuality, having hire personnel, and caregivers being daughter-in-law, predicted 27.2% of the total variances in overall role strain outcome. Family caregivers who reported worse mutuality predicted higher role strain from caregiving activities. Mutuality was the best predictor and was able to explain 10.6% of the variances in overall role strain outcome independently. The results of this study may help clinical nurses to understand mutuality and role strain from caregiving activities in family caregivers of patients with dementia. It may also provide guidance to development of individualized care plan and interventions to improve family caregivers’ ability, and was provide a reference for future research.

碩士
臺北市立大學
視覺藝術學系
106
Recent studies on dementia patients and their caregivers shed light on the importance of interactions and relationships between the two. This research examines how group art therapy affects interactions and relationships between dementia patients and their family caregivers. Ten families, each containing a dementia patient and his/her family caregiver(s), were recruited into a group art therapy program designed to enhance interactions and relationships within family members. The program lasts 9 weeks, 1 session per week, 30 hours in total. After the program ends, 4 participants, who are caregivers and have child-parent relationships with the patients, are interviewed with a semi-structural questionnaire. Results show that the program affects interactions and relationships between dementia participants and their caregiving respondents by making the caregivers (1) contemplate the interactions and the relationships, (2) make self reflections and adjustments, (3) look deeper into the patients’ psyche, (4) promote the autonomy of the patients, (5) experience new interactions and relationships during the sessions, (6) experience affectionate interactions, (7) transcend losses and regrets, (8) discover meanings and wills for caretaking within child-parent relationships, (9) generate new mindsets facing life and the patients, (10) improve personal wellbeing, (11) obtain social supports and senses of belonging, (12) improve abilities of caretaking, (13) improve daily life interactions.

The purpose of this study was to explore how Korean American caregivers view dementia caregiving and analyze the role of culture in their attitude toward caregiving. Demographic characteristics, stressor factors, social support factors, and cultural factors were examined in the model. Stressor factors were measured by care receivers' problem behaviors, duration of caregiving, and amount of caregiving. Social support factors were composed of the amount of social support and the quality of social support. Cultural factors included level of acculturation, years in the U.S., filial piety, and familism. The study compared a group of spouse caregivers with a group of children providing care in order to investigate the differences in their attitude toward caregiving. In addition, the interaction effect between social support and acculturation on dementia caregiver's attitude toward caregiving was examined. Eighty five Korean American dementia caregivers participated in the survey through a convenience sampling method. Among the Korean American dementia caregivers, child caregivers showed a more positive attitude toward caregiving then spouse caregivers. The effects of social support on caregivers' attitude toward caregiving did not vary with the level of acculturation. Hierarchical multiple regression analysis indicated that, among the study factors including stressor factors, social support factors, and cultural factors, only social support factors contributed significantly to Korean American dementia caregivers' positive attitude toward caregiving. Among the predictors of Korean American dementia caregivers' attitude toward caregivng, the amount of caregiving per day was the most significant variable, followed by the quality of social support and care receivers' problem behaviors. Higher levels of daily caregiving and higher quality of social support were positively related to positive attitude toward caregiving. A higher level of care receivers' problem behaviors was negatively related to positive attitude toward caregiving. Comparison of the beta coefficients from the spouse caregiver group and nonspouse caregiver group revealed that there was a discrepancy of predictors of Korean American caregivers' attitude toward caregiving between the two caregiving groups. The model had a better fit for immigrant spouse caregiver groups indicated by significantly different R² from spouse caregivers and non-spouse caregivers, 85% and 33%, respectively. The results of this study imply the importance of incorporating cultural diversity in social policy. Because of the salient findings in this study, inclusion of content on increasing and enhancing quality of social support is recommended for social work practice with Korean American dementia caregivers.

碩士
長庚大學
護理學研究所
95
The purpose of this study was to explore the relationships between the caregiving process of "Finding a Balance Point" and quality of life in family caregivers of older persons with dementia using a secondary data analysis. The original data was from Shyu’s research project entitled “Family Care for Persons with Alzheimer's Disease in Taiwan and the US: Development and Testing of a Cross-National Family Care Inventory”, which was funded by the National Science Council. One hundred and seventy-five dyads of elderly persons with dementia and their family caregivers were recruited in this study. The average age of the caregivers was 51.6 (SD=12.4), females were majority (52.6%), and most of them have junior college/university or higher educational background (43.4%). The conceptual framework of this study was modified from Shyu's model of "finding a balance point". Instruments were a structured questionnaire including demographic characteristics of the participants, the Caregiving Process of Finding a Balance Point Scale, and a Chinese version of Short Form-36 (SF-36). Study findings revealed that caregivers who were better at predicting existing competing needs were better at finding a balance point in the caregiving process. For different dimensions of quality of life, the important predictors were: duration of dementia, the number of co-morbidity and MMSE scores of the older persons, as well as whether the caregiver living with the care receiver, gender of caregiver, age of caregiver, educational levels of caregiver, the relationship with patient, caring hour per day, the degree of “competing needs”, and the degree of “finding a balance point”. These predictors explained 10.3% to 26.4% of the variance of quality of life. Among these predictors, “competing needs” was the best variable for prediction, and was able to explain 2.4% to 9.9% of the variance of quality of life. “Competing needs” directly influenced the quality of life of the caregiver. It predicted that the more “competing needs” the caregivers faced, the worse quality of life the caregivers had. In addition, caregivers being better at “finding a balance point”, his/her scores on mental component were more positive; and that was able to explain 2.3 % of the variance. The results of this study will enable nurses to understand the caregiving process of "Finding a Balance Point" and quality of life in family caregivers of patients with dementia. It may also provide guidance to develop nursing interventions, to make proper referrals, and to provide a reference for future research.

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)

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

Dementia of Alzheimer‟s Type is a degenerative neurocognitive disease accounting for majority of Dementia‟s. It affects millions of people worldwide and thousands of people in South Africa. Apart from the economic burden this illness places on the country, it has detrimental effects for those who provide care for individuals with this illness, who are mostly spouses. The spousal caregivers bears great financial, social and emotional burden which worsens as the disease progresses. The aim of this study is to phenomenologically explore and describe the lived experiences of spousal caregivers in caring for the spouses with Dementia of Alzheimer‟s Type. This South African study was therefore qualitative in nature and was conducted in the province of KwaZulu- Natal, in the city of Pietermaritzburg. Eight participants were interviewed using a semi-structured questionnaire. Data was analysed using interpretative phenomenological analysis (IPA). The main findings of this study are the negative emotional affects that the caregiving role creates. Caregiver stress and strain is experienced as well as the experiences of various losses including lack of intimacy and ruined expectations for the future as the disease progresses. The caregiving role also created negative implications for the social lives of caregivers and coping mechanisms were seen to be very important.
Psychology
M.A. (Psychology)