Hava Golander

Self-identity in older persons suffering from dementia : preliminary results

In this study, we explored the role-identity of nursing home residents suffering from dementia, as well as the potential for utilizing their enduring sense of self-identity for enhancing their quality of life. Four types of role-identity were explored: professional, family-role, leisure activities, and personal attributes. The methodology included structured interviews and a case study. Participants for the interviews were 38 residents of two nursing homes in Israel. Residents, relatives, and staff members were interviewed to provide information about past roles and the degree to which those roles are maintained in the present, and about strategies for bolstering the sense of self-identity. A large range of roles were identified. All role identities deteriorated significantly, with family roles retaining the greatest prominence in the present. However, much heterogeneity was manifested in all roles. Both staff members and relatives felt that a sense of identity in residents could be enhanced in most of the residents, which would exert a beneficial effect on their well-being. Caregiving respondents anticipated that this improvement would be substantial for about half of the residents. The case study illustrates how self-identity can change throughout dementia, and how it can be utilized to improve quality of life.

The Mask of Dementia: Images of ‘Demented Residents’ in a Nursing Ward

A description of the social construction of dementia among elderly residents of a nursing ward is offered, based on ethnographic fieldwork conducted in an Israeli geriatric centre. This account focuses on the construction of positive social identities and the ascription of roles for residents labelled as ‘demented’. The findings illustrate the split between personal and social identity in dementia. The applicability of conventional socio-psychological constructs such as ‘I’ and ‘me’ regarding dementia is questioned, as the spoken manifestations of these constructs is critically examined from a symbolic interactionist perspective.

The meanings of delusions in dementia: A preliminary study

One of the common symptoms of dementia is delusions. Due to a biological conceptualization of the behaviors represented as delusions, these are classified as psychotic symptoms. This is a qualitative and quantitative study aiming to describe the delusions experienced by older persons with dementia and the context of occurrence, and to elucidate their etiology. Participants were 74 nursing home residents aged 65 and over, diagnosed with dementia, from nine nursing homes in Israel. Participants with delusions were found to have significantly more difficulties in performing ADLs, and poorer vision and hearing. Based on assessment using the BEHAVE-AD, six categories of delusions were examined: 1. Ones house is not ones home, 2. Theft, 3. Danger, 4. Abandonment, 5. Misidentification, and 6. Other non-paranoid. Common themes appeared across delusions including reality, disorientation, re-experience of past events, loneliness and insecurity, boredom, and trigger. Current results suggest that delusions may not represent psychotic symptoms for most participants, because they sometimes represented reality, or were neither firm nor incontrovertible. Thus, utilizing the term delusion relegates the persons behavior to the domain of severe psychiatric phenomena and precludes understanding its true meaning.

Which Stress Matters? The Examination of Temporal Aspects of Stress

In this study, the impact of past experiences, present stressors, and expectations of future stress on psychological distress were explored. Participants were 38 male and 41 female spouses of patients hospitalized with non-life-threatening diseases. Participants completed questionnaires on which they appraised past, present, and future stressors and described their levels of psychological distress. Five models of the relationships between appraisals of past, present, and future stressors with psychological distress were examined. Only one model was confirmed by the data. It suggests that an appraisal of past stressors affects the appraisal of present stressors only indirectly, through its effect on the appraisal of future stressors. This model also maintains that only the appraisal of present stressors affects psychological distress directly. The implications of these findings for stress research are discussed.

The measurement of psychosis in dementia: a comparison of assessment tools.

The precise operational definition of psychosis in dementia lacks consensus, partially owing to incongruence in the various assessment tools used. This study compares assessments of psychotic symptoms in persons with dementia, specifically of hallucinations and delusions, through the 4 most frequently used assessments. Participants were 74 nursing home residents from 9 nursing homes in Israel, diagnosed with dementia. Assessment tools used included the Behavioral Pathology in Alzheimers Disease Rating Scale (BEHAVE-AD), the Neuropsychiatric Inventory-Nursing Homes (NPI-NH), the Consortium to Establish a Registry for Alzheimers Disease Behavior Rating Scale for Dementia (CERAD-BRSD), and the Columbia University Scale for Psychopathology in Alzheimers Disease (CUSPAD). The highest prevalence rates of delusions were found through the CUSPAD, and the lowest through the CERAD-BRSD. Rates identified by the BEHAVE-AD were intermediate and similar to those of the NPI-NH. As for hallucinations, rates indicated by the BEHAVE-AD, the NPI-NH, and the CUSPAD were similar, with small sample-based differences, and higher than those found through the CERAD-BRSD. The CERAD-BRSD, soliciting reports of the fewest specific symptoms, detected the fewest psychotic symptoms. The CUSPAD, soliciting the most items, presented the highest prevalence rates. The BEHAVE-AD and the NPI-NH had similar rates and showed a high convergent validity.

Ageism among physicians, nurses, and social workers: findings from a qualitative study

This study investigated ageism among healthcare professionals in various therapeutic settings in Israel. Using a qualitative approach, the current study aimed to examine similarities and differences across healthcare disciplines. Three focus groups were conducted with physicians, nurses, and social workers. Data from each focus group were analyzed separately, and then commonalities and differences across the groups were evaluated. Three main themes relating to older adults emerged from the data. The first theme pertains to perceived difficulties that healthcare professionals experience in working with older adults and their family members; the second focuses on invisibility and discriminatory communication patterns; and the third theme relates to provision of inappropriate care to older adults. Similarities and differences across the three disciplines were found. The differences related mainly to the examples provided for manifestations of ageism in the healthcare system. Provision of inadequate treatment to older adults due to their age appeared to be the most complex theme, and is discussed at length in the Discussion. Briefly, the complexity stems from the fact that although some behaviors can be clearly described as inappropriate and undesirable, other behaviors such as avoidance of invasive medical procedures for older patients raise ethical dilemmas. Potentially, avoidance of invasive medical treatment can be perceived as compassionate care rather than as undertreatment due to ageist perceptions. A related dilemma, i.e., longevity versus quality-of-life, is also discussed in light of the finding that the balance of these two aspects changes as patients grow old.

Rituals of temporality: The social construction of time in a nursing ward

Abstract This article examines how institutionalized life and its interactional dynamics are combined by the elderly in order to construct a unique time perspective. It is based on a four year anthropological fieldwork conducted in the nursing ward of a large geriatric center in Israel. The ethnography describes three time-structuring processes: (1) Revising the Past—constituting boundaries between past and present through “obiographies of illness”; (2) Denying the Future—constructing boundaries between present and future throuh a distinct perception of death and dying; and (3) Arresting Time—stituting the present as boundless through the construction of “limbo time”. It discusses how the wards ‘clockwork environment’ of rigid schedule and daily activities serves as a framework for these processes, whose ultimate goal is to defy the regime of the clock.

Does late onset depression predispose to dementia? A retrospective, case-controlled study

BACKGROUND Recent research suggests that there are clinical and biologic characteristics typical of late onset depression (LOD). Furthermore, evidence has been put forward that LOD may be a prodrome of dementia. OBJECTIVE This study aims to assess the association between LOD and the development of dementia. SETTING The study was conducted in a tertiary care, university-affiliated mental health center providing services for an urban catchment population of 800,000 subjects. METHOD A retrospective, case-controlled study was used. RESULTS Fifty-one patients with LOD who developed dementia at least 1 year after diagnosis of LOD were defined as the index group: 18 males and 33 females, with a mean age of 75.4 ± 9.2 years. These were compared with 51 patients with LOD who did not develop dementia during a 10-year follow-up period. Dementia types were as follows: 73% Alzheimer disease, 24% vascular and mixed dementia, and 3% Parkinson dementia. Patients with LOD who developed dementia were significantly characterized by having longer hospitalization for their first depressive episode (P = .048), having a family history of dementia (P = .022), and having been exposed to the Holocaust as young adults (P = .013). CONCLUSIONS Patients with a history of significant traumatic experience in early life and a prolonged onset of depression may be at particular risk of developing dementia. This issue requires further long-term prospective studies.

The impact of psychotic symptoms on the persons with dementia experiencing them

OBJECTIVE To portray the emotional and behavioral reactions of persons with dementia to the delusions and hallucinations they experience, according to the reports of their family caregivers. The article also explores the relationship between those reactions and background variables. METHODS Study participants were family caregivers of 74 older persons with a diagnosis of dementia (aged ≥ 65) residing in the community recruited from adult day centers and support groups for caregivers of persons with dementia and by advertising online. Assessments included the Behavioral Pathology in Alzheimers Disease, the Neuropsychiatric Inventory, the Etiological Assessment of Psychotic Symptoms in Dementia, Activities of Daily Living questionnaire, and the Mini-Mental State Examination. RESULTS Findings concerning emotional reactions reveal that close to half of the delusions resulted in discomfort, whereas around 40% did not. We found significant differences in the discomfort associated with different types of delusions, with delusions of abandonment, danger, and infidelity associated with more discomfort than other delusions. Around half of the delusions were associated with a behavioral manifestation. CONCLUSION The findings highlight the need to examine the emotional impact of delusions and hallucinations as part of their assessment and as a consideration in treatment decisions.

Balancing psychache and resilience in aging Holocaust survivors.

BACKGROUND Psychache can and does co-exist alongside resilience and coping amongst trauma survivors. This has been the center of the a-integrative theory of aging demonstrating an attitude to life based on cognitive and emotional dimensions. Aging of Holocaust survivors (HS) is especially difficult when focus is brought to the issue of integrating their life history. The present study aimed to investigate the interplay between psychache and resilience amongst aging HS. METHODS Cross-sectional study of HS and a matched comparison group recruited from the general population was carried out. All underwent a personal interview and endorsed quantifiable psychache and resilience scales. RESULTS We enrolled 214 elderly participants: 107 HS and 107 comparison participants. Mean age for the participants was 80.7± years; there were 101 women and 113 men in each group. Holocaust survivors did not differ in the level of resilience from comparisons (mean: 5.82 ± 0.68 vs. 5.88 ± 0.55, respectively). Psychache was significantly more intense in the HS group (F(8,205) = 2.21; p < 0.05). CONCLUSIONS The present study demonstrates the complex interplay between psychache and resilience. Aging HS still have to cope with high levels of psychache while realizing a life-long process of development through resilience.