John Spreadbury

Spiritual belief, social support, physical functioning and depression among older people in Bulgaria and Romania

Objectives: An exploratory investigation is reported into the role of spirituality and religious practice in protecting against depression among older people living in rural villages in Bulgaria and Romania, two neighbouring countries with similar cultural, political and religious histories, but with differing levels of current religiosity. Methods: In both countries, interviews were conducted with samples of 160 persons of 60 years and over in villages of similar socio-economic status. The Hospital Anxiety and Depression-D scale and the Royal Free Interview for Religious and Spiritual Beliefs were used to assess depression and spiritual belief and practice respectively. In addition social support, physical functioning and the presence of chronic diseases were assessed. One year later, follow-up interviews were conducted with 58 of the original sample in Bulgaria, in which additional measures of depression and of spiritual belief and practice were also included. Results: The study demonstrates, as expected, significantly lower levels of spiritual belief in the Bulgarian sample (Bulgarian mean 29.7 (SD = 19.1), Romanian mean 47.6 (SD = 11.2), t = 10.2, p < 0.001), as well as significantly higher levels of depression (Bulgarian mean 12.0 (SD = 4.9), Romanian mean 7.3 (SD = 4.1), t = 9.3, p < 0.001), the latter attributable in large part to higher morbidity and disability rates, but less evidently to differences in strength of belief. However, analyses from both the cross-sectional study and the one-year follow-up of the Bulgarian sample do suggest that spiritual belief and practice may both influence and reflect physical and mental illness. Conclusions: Much of Eastern Europe displays high rates of depression among its older population and provides opportunities for investigation of the role of religious belief and practice in preventing and coping with depression. Further research is encouraged in populations of diverse religiosity.

A pilot randomised controlled trial to compare changes in quality of life for participants with early diagnosis dementia who attend a ‘Living Well with Dementia’ group compared to waiting-list control

Objectives: The aim of this paper is to report a pilot study in which participants who had recently received a diagnosis of dementia were randomised to either a 10-week group intervention or a waiting-list control. Method: Memory clinic staff with limited previous experience of group therapy were trained to lead a 10-week group therapy intervention called ‘Living Well with Dementia’. Fifty-eight participants, all of whom had received a diagnosis of Alzheimers disease, vascular or Lewy body dementia within the previous 18 months, were randomised to receive either the intervention or treatment as usual (waiting-list control). Data collection occurred at baseline, within two weeks after the intervention finished and at 10-week follow-up. Results: The study met its recruitment targets, with a relatively low attrition rate for the intervention arm. The acceptability of the intervention and research methods was examined qualitatively and will be reported on elsewhere. For the primary outcome, measure of quality of life in Alzheimers disease (QoL-AD), and secondary outcome, self-esteem, there was some evidence of improvement in the intervention group compared to the control group. There was, also, evidence of a reduction in cognitive functioning in the treatment group compared to the control. Such reported differences should be treated with caution because they are obtained from a pilot and not a definitive study. Conclusion: This pilot study succeeded in collecting data to inform a future definitive cost effectiveness clinical trial of Living Well with Dementia group therapy.

Measuring younger onset dementia: A comprehensive literature search of the quantitative psychosocial research.

Background Research is beginning to demonstrate the unique psychosocial effects of young onset dementia. Theorising remains at an early stage and there has been little discussion about measurement and methodological issues. Our aim was to conduct a comprehensive literature search of the young onset dementia psychosocial research, and to identify the domains of experience measured with patients and caregivers. Method We conducted a search of five electronic databases (Medline, CINAHL, PsycINFO, Embase, the Cochrane Library) using equivalent database controlled vocabulary terms. We supplemented this search by using free text searches within electronic databases, searching reference sections of salient papers, and using online search engines. We defined psychosocial as referring to patient and caregiver psychological, behavioural, and social functioning in the context of living with young onset dementia. Results We identified 72 published articles, 49 quantitative and 23 qualitative. The quantitative articles form the focus of the present review. We identified 10 domains of patient experience measured and 14 domains of caregiver experience. The patient domains measured most often were behaviour, cognition, functioning, and severity, and reflected a focus on symptoms and clinical features. Quality of Life (QoL) was the patient domain measured least often. The caregiver domains measured most often were mental health and burden, and reflected a focus on psychological well-being and coping. Conclusion The scope of measurement is broader in caregivers than patients. QoL although under-researched may be a useful domain to measure in future research. Risk factors, measurement and methodological issues are discussed.

Haven't we met before? The effect of facial familiarity on repetition priming

Within the word recognition literature, word-frequency and hence familiarity has been shown to affect the degree of repetition priming. The current paper reports two experiments which examine whether familiarity also affects the degree of repetition priming for faces. The results of Experiment 1 confirmed that familiarity did moderate the degree of priming in a face recognition task. Low familiarity faces were primed to a significantly greater degree than high familiarity faces in terms of accuracy, speed, and efficiency of processing. Experiment 2 replicated these results but additionally, demonstrated that familiarity moderates priming for name recognition as well as face recognition. These results can be accommodated within both a structural account of repetition priming (Burton, Bruce & Johnston, 1990) and an Episodic Memory account of repetition priming (see Roediger, 1990), and are discussed in terms of a common mechanism for priming, learning and the representation of familiarity.

Markers of assimilation of problematic experiences in dementia within the LivDem project

This study aimed to determine whether the Markers of Assimilation of Problematic Experiences in Dementia scale (MAPED) can be used to identify whether the way in which participants talk about dementia changed during the group. All eight sessions of a LivDem group, which were attended by participants were recorded and transcribed. An initial analysis identified 160 extracts, which were then rated using the MAPED system. Inter-rater reliability was 61% and following a resolution meeting, 35 extracts were discarded, leaving 125 extracts with an agreed marker code. All of the participants were identified as producing a speech marker relating to dementia, and these varied between 0 (warding off) to 6 (problem solution). Examples of these markers are provided. The proportion of emergence markers (indicating the initial stages of assimilation) compared to later markers changed significantly between the first four sessions and the final sessions. This difference was still significant even when the markers produced by the most verbal participant, Graham, were excluded. The use of process measures within psychotherapy complements more conventional outcome measures and has both theoretical and clinical implications.

Measuring younger onset dementia: What the qualitative literature reveals about the ‘lived experience’ for patients and caregivers

Background The qualitative research on young onset dementia is providing insights about the ‘lived experience’ of patients and caregivers. However, findings from these studies have seldom been integrated into descriptive overviews. Our aim was to search the qualitative research, to integrate the qualitative findings, and offer an account of the lived experience for patients and caregivers. Method The search of the qualitative research formed part of a broader comprehensive literature search investigating salient measurement issues in the young onset dementia psychosocial research. Five electronic databases were searched (Medline, CINAHL, PsycINFO, Embase, the Cochrane Library) plus supplementary searching of reference sections and use of online search engines. We identified 23 qualitative articles. Results In the pre-diagnostic period, patients experience changes in cognition and functioning but may be uncertain about changes and their significance. Caregivers may observe changes, think of explanations, and are important in instigating medical intervention. Obtaining a diagnosis may be a demanding process and the possibility of dementia may not be anticipated. In the post-diagnostic period, patients and caregivers use several strategies to cope and adjust. Patients can withdraw from established responsibilities while caregivers assume compensatory roles/duties. Patients perceive changes in their identity while caregivers perceive changes in the caregiver–patient relationship. Both can experience grief, isolation, and stigma. Discussion The diagnosis of dementia elicits significant changes in thinking, emotion, and lifestyle that patients and caregivers are unlikely to be ready for. Both receive insufficient support or guidance in particular of a psychological nature on how to cope and adjust.

Psychological Aspects of Bereavement in Adults: Preliminary Development of the Bereavement Experiences Index

This studys aim was to produce a measure of the cognitive and affective impact of bereavement and to investigate the psychometric properties and potential utility of the measure. Using a mixed correlational and comparative design, the bereavement experiences of widows who had time to anticipate their partners death were compared with those who had no such time. In the first stage of this two-stage study, seven widows completed semi-structured interviews regarding bereavement-related cognitions and affect. A set of bereavement-related statements was derived and formed the Bereavement Experiences Index (BEI). In the second stage, the BEI and a measure of psychological disturbance were administered to 20 additional widows. Unexpected bereavement led to greater psychological impact than expected loss although longer periods of expectation were positively correlated with higher levels of grief-related social dysfunction symptoms. This preliminary version of the BEI showed potential as a measure of grief responses with predictable links to psychological distress. The findings suggested a relationship between the time available to prepare for a loss and the development of psychological disturbance.

Imaging Care Requirements: Use of Functional Neuroimaging to Predict Dementia Caregiver Burden

Background: Dementia caregivers frequently report high stress, with increased burden associated with worse outcomes for both patients and caregivers. Although many studies relate clinical phenotypes to burden, the relationship between imaging pathology and burden, irrespective of diagnosis, is unknown. This study investigated the relationship between caregiver burden and patient regional cerebral blood flow in dementia. Methods: Seventy-sev en patients with cognitive impairment undergoing brain perfusion single-photon emission computed tomography imaging in normal clinical care and their caregivers were recruited. Caregiver burden was ranked from “little” to “severe” using the Zarit Burden Interview and perfusion values extracted from the patient images for predefined regions of interest. The associations between burden score and regional function on imaging were tested. Results: Burden score was significantly higher for caregivers of patients with abnormal perfusion compared to those with normal perfusion in the left and right frontal, right parietal, and right temporal lobes. No difference in burden was found in the left parietal or temporal groups. Correlations showed that a higher caregiver burden was associated with lower patient perfusion scores in the same regions. Conclusion: Caregiver burden is strongly related to the extent of frontal or right-predominant parietal or temporal lobe dysfunction. Regional abnormality on perfusion imaging can be used to facilitate identification of individuals who are likely to create a high burden on caregivers.

Living well with dementia groups: changes in participant and therapist verbal behaviour.

ABSTRACT Objectives: This paper reports two related analyses of verbal material from seven Living Well with Dementia groups: the first examines changes in the verbal behaviours of participants across the course of the sessions in all seven groups; while the second contrasts therapist behaviour in two groups. Methods: In the first analysis, recordings of three sessions from each group were transcribed and participant descriptions of dementia were analysed using the Markers of Assimilation of Problematic Experiences of Dementia (MAPED) rating procedure. In the second analysis, therapist behaviour in weeks 2 and 8 from two groups (F and G) was analysed using the Hill Counsellor Verbal response rating scale. Inter-rater reliabilities for the two sets of ratings were ‘good’ and ‘very good’, respectively. Results: For the MAPED ratings, a five by four contingency table was analysed using chi-squared, which indicated a highly significant change in assimilation. There were significant higher levels of level 1 and 2 markers in the first two sessions and level 4 for sessions 5 and 6. Facilitators used significantly more direct guidance and information giving behaviour in the second session at Location F compared to Location G. Conclusions: The results suggest that important changes occurred in the way that dementia was described across the seven LivDem groups: this includes both reductions in the avoidance of direct references to dementia after the first two sessions, as well as an increase in ‘insight’ statements. Directive facilitator behaviour may be associated with poorer outcomes.

IMPORTANT ISSUES IN YOUNG ONSET DEMENTIA CARE: THE PERSPECTIVE OF HEALTHCARE PROFESSIONALS

and leisure activities and activities in the outdoor space. PWDs seldom translate difficulties with activities of daily life into needs. From their own values and beliefs, professionals sometimes question whether the formulated needs are the most essential needs. In some instances, a clearer grasp of the meaning of clients’ unmet needs would enable better addressing clients’ real needs. Conclusions:Active client involvement in the needs assessment process is important, but also challenging. An example is the dilemma of PWDs reporting no specific needs, while professionals and caregivers notice ‘neglected’ futureneeds. We will discuss the needs assessment technique and the professional’s role in helping clients to determine what is most important to them. Being proactive in setting future-needs and goals will be important to guarantee the PWDs quality of life.