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Välbefinnande och demens: Aspekter på välbefinnande hos äldre personer med måttlig till svår demens
Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
2011 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Personer som lever med demenssjukdom såväl som mentalt friska människor behöver uppleva välbefinnande. Ett viktigt mål i vården och omsorgen av personer med demens är därför att hitta vägar för att försöka främja välbefinnande hos personen. Avhandlingens övergripande syfte varatt utveckla kunskap om aspekter av betydelse för att äldre personer med måttlig till svår demens ska uppleva välbefinnande.

Avhandlingen baseras på empiriskt material från fyra delstudier. Den första delstudien, I(etnografi) genererade fältanteckningar från 31 observationstillfällen samt nio kvalitativa intervjuer med vårdgivare, så kallade kontaktmän till personen med demens. Delstudie II(testutveckling/tvärsnittsstudie) utgjordes av 336 testprotokoll som bearbetades statistiskt. Materialet i delstudie III (reformulerad grundad teori) innefattade 18 kvalitativa intervjuer med personer med demens samt 18 observationsprotokoll från observation av icke-verbalt språk. Den sista delstudien (IV) (konstruktivistisk grundad teori) bestod av fältanteckningar från 24 videoinspelningar av Egentids-situationer och 24 kvalitativa intervjuer med personer med demens samt åtta kvalitativa intervjuer med vårdgivare.

Resultatet från avhandlingens studier visar att de kognitivt friska personerna som finns i personens närhet har en avgörande betydelse för upplevelsen av välbefinnande hos personer med måttlig till svår demens. För att interaktion ska vara önskvärd och ge välbefinnande måste den mentalt friska parten ha kunskap och insikt om att det finns en större medvetenhet hos personen med måttlig till svår demens än vad det omedelbara intrycket av förmågor ger. Om denna insikt saknas finns risk att interaktionen kan leda till kränkning i stället för välbefinnande. Det är förmodligen av betydelse att ha kunskap om och försöka fånga personens kvarvarande förmågor istället för att fokusera på brister. Kunskap om kvarvarande förmågor och till exempel överinlärda förmågor som fångas i anpassade test kan bidra till en mer positiv syn på personen och innebära att kvarvarande förmågor bättre tas tillvara, vilket kan bidra till välbefinnande. Personen med måttlig till svår demens kan kommunicera ett välbefinnande men det kräver lyssnarens förmåga och förmåga att tolka. Det kan också kräva en del praktiska ansträngningar med hänsyn till personens kognitiva nedsättningar som till exempel hjälpmedel i form av bilder och ting. Förmodligen ger interaktion som leder till en relation alltid en upplevelse av välbefinnande. Tid är en avgörande faktor för att upprätta relationer som ger välbefinnande hos personer med måttlig till svår demens. Det är därför viktigt att i vården avsätta tillräcklig tid, som vid till exempel Egentid, för att upprätta relationer och därigenom främja välbefinnande.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences , 2011. , 111 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 19
Keyword [sv]
Välbefinnande, demens, interaktion, kognition, kommunikation, relationer, Egentid
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-15895ISBN: 978-91-85835-18-8 (print)OAI: oai:DiVA.org:hj-15895DiVA: diva2:436212
Public defence
2011-09-16, Kurt Johansson aulan , Hälsohögskolan, Barnarpsgatan 39, Jönköping, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2011-08-22 Created: 2011-08-22 Last updated: 2011-11-21Bibliographically approved
List of papers
1. Sliding interactions: An ethnography about how persons with dementia interact in housing with care for the elderly.
Open this publication in new window or tab >>Sliding interactions: An ethnography about how persons with dementia interact in housing with care for the elderly.
2011 (English)In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 10, no 4, 523-538 p.Article in journal (Refereed) Published
Abstract [en]

This ethnography describes how persons with dementia interact with cognitively intact persons in housing with care for the elderly. The results, drawing upon 31 observation sessions and nine interviews, are described under the following themes, which were interpreted from the standpoint of social interaction theory: interaction with expression of satisfaction, disorientation, and dissociation. Interaction provided satisfaction, but did not always reflect a positive experience. Awareness in persons with dementia seemed to be greater than others perceived and, as a result, interaction was adversely affected by frequent well-intentioned corrections and comments. Participation in interaction can be encouraged and feelings of indignation avoided by assuming that persons with dementia are aware of their situation and how others behave toward them. Sensitivity is required to interpret individuals' expressions of desire not to participate, while simultaneously it is important to try to interpret why they want to refrain.

National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-16730 (URN)10.1177/1471301211409376 (DOI)
Projects
Avhandling
Available from: 2011-11-16 Created: 2011-11-16 Last updated: 2017-12-08Bibliographically approved
2. KUD- a scale for clinical evaluation of moderate-to-severe dementia
Open this publication in new window or tab >>KUD- a scale for clinical evaluation of moderate-to-severe dementia
Show others...
2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 11-12, 1542-1552 p.Article in journal (Refereed) Published
Abstract [en]

Aim.  To develop a test of cognitive performance in persons with moderate-to-severe dementia.

Background.  Various instruments are used to assess the course of dementia and to evaluate treatments in persons with dementia. Most neuropsychological assessments are inappropriate for measuring cognitive abilities in persons with severe dementia, because these persons perform at floor level in such measurements.

Design.  A cross-sectional research design.

Methods.  The test (Clinical Evaluation of Moderate-to-Severe Dementia; Swedish acronym: KUD) was developed from a pool of 25 test items with the final KUD consisting of 15 items. Reliability and validity were established using 220 subjects (with various dementia diagnoses) with scores of Mini-Mental State Examination between 0–20. Approximately two weeks after the first test, 116 of the original 220 subjects were retested.

Results.  A factor analysis with the 15-item scale revealed an interaction factor comprising three items and a cognitive performance factor with 12 items. The internal consistence reliability was 0·93 for the KUD (Cronbach’s alpha). Test–retest reliability was also high (0·92) and correlation between the KUD and the MMSE (≤20) was high (r = 0·80).

Conclusion.  The KUD seems to be a valid, reliable performance-based assessment scale for measuring cognitive performance in persons with MMSE score below 12 or 15 points.

Relevance to clinical practice.  It is of outmost interest that cognitive performance can be easily followed for persons with moderate-to-severe dementia in, for example, drug therapies and other therapies, but also in terms of treatment of and support to the person based on his or her abilities.

Keyword
cognition, dementia, functional ability, KUD, measurement, performance-based assessment
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-15536 (URN)10.1111/j.1365-2702.2010.03619.x (DOI)
Available from: 2011-06-22 Created: 2011-06-22 Last updated: 2017-12-11Bibliographically approved
3. The meaning of oral health-related quality of life for elderly persons with dementia
Open this publication in new window or tab >>The meaning of oral health-related quality of life for elderly persons with dementia
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2009 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 67, no 4, 212-221 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-8628 (URN)10.1080/00016350902855296 (DOI)
Available from: 2009-08-14 Created: 2009-05-05 Last updated: 2017-12-13Bibliographically approved
4. Creating relationships with persons with moderate to severe dementia
Open this publication in new window or tab >>Creating relationships with persons with moderate to severe dementia
2013 (English)In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 12, no 1, 63-79 p.Article in journal (Refereed) Published
Abstract [en]

The study describes how relationships are created with persons with moderate to severe dementia. The material comprises 24 video sequences of Relational Time (RT) sessions, 24 interviews with persons with dementia and eight interviews with professional caregivers. The study method was Constructivist Grounded Theory. The categories of 'Assigning time', 'Establishing security and trust' and 'Communicating equality' were strategies for arriving at the core category, 'Opening up', which was the process that led to creating relationships. Both parties had to contribute to create a relationship; the professional caregiver controlled the process, but the person with dementia permitted the caregiver’s overtures and opened up, thus making the relationship possible. Interpersonal relationships are significant to enhancing the well-being of persons with dementia. Small measures like RT that do not require major resources can open paths to creating relationships.

Keyword
dementia, relationship, relational time, well-being
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-16762 (URN)10.1177/1471301211418161 (DOI)
Available from: 2011-11-21 Created: 2011-11-21 Last updated: 2017-12-08Bibliographically approved

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