Lesley Wilson

A meta-review of stress, coping and interventions in dementia and dementia caregiving

BackgroundThere has been a substantial number of systematic reviews of stress, coping and interventions for people with dementia and their caregivers. This paper provides a meta-review of this literature 1988-2014.MethodA meta-review was carried out of systematic reviews of stress, coping and interventions for people with dementia and their caregivers, using SCOPUS, Google Scholar and CINAHL Plus databases and manual searches.ResultsThe meta-review identified 45 systematic reviews, of which 15 were meta-analyses. Thirty one reviews addressed the effects of interventions and 14 addressed the results of correlational studies of factors associated with stress and coping. Of the 31 systematic reviews dealing with intervention studies, 22 focused on caregivers, 6 focused on people with dementia and 3 addressed both groups. Overall, benefits in terms of psychological measures of mental health and depression were generally found for the use of problem focused coping strategies and acceptance and social-emotional support coping strategies. Poor outcomes were associated with wishful thinking, denial, and avoidance coping strategies. The interventions addressed in the systematic reviews were extremely varied and encompassed Psychosocial, Psychoeducational, Technical, Therapy, Support Groups and Multicomponent interventions. Specific outcome measures used in the primary sources covered by the systematic reviews were also extremely varied but could be grouped into three dimensions, viz., a broad dimension of “Psychological Well-Being v. Psychological Morbidity” and two narrower dimensions of “Knowledge and Coping” and of “Institutionalisation Delay”.ConclusionsThis meta-review supports the conclusion that being a caregiver for people with dementia is associated with psychological stress and physical ill-health. Benefits in terms of mental health and depression were generally found for caregiver coping strategies involving problem focus, acceptance and social-emotional support. Negative outcomes for caregivers were associated with wishful thinking, denial and avoidance coping strategies. Psychosocial and Psychoeducational interventions were beneficial for caregivers and for people with dementia. Support groups, Multicomponent interventions and Joint Engagements by both caregivers and people with dementia were generally found to be beneficial. It was notable that virtually all reviews addressed very general coping strategies for stress broadly considered, rather than in terms of specific remedies for specific sources of stress. Investigation of specific stressors and remedies would seem to be a useful area for future research.

'It's like having a day of freedom, a day off from being ill': exploring the experiences of people living with mental health problems who attend a community-based arts project, using interpretative phenomenological analysis.

To explore the psychosocial benefits of participating in a 2-year community arts project, eight people living with long-term mental health problems were interviewed. The project involved participants in selecting items of professional artwork, creating personal responses and curating a public exhibition. Interviews were analysed using interpretative phenomenological analysis. Participants experienced the arts project as improving self-worth, emancipating self from illness labels, offering a sense of belonging, enabling acquisition of valued skills and offering meaningful occupation and routines. Some regarded their developing creative skills as improving their self-management of mental health. However, some anticipated the project’s ending with anxiety.

The Effectiveness of Origami on Overall Hand Function After Injury: A Pilot Controlled Trial

This pilot study measured the effectiveness of using origami to improve the overall hand function of outpatients attending an NHS hand injury unit. The initiative came from one of the authors who had used origami informally in the clinical setting and observed beneficial effects. These observed effects were tested experimentally. The design was a pilot non-randomised controlled trial with 13 participants. Allocation of the seven control group members was based on patient preference. The experimental group members attended a weekly hour of origami for six weeks, in addition to their conventional rehabilitation. Hand function of all participants was measured using the Jebsen-Taylor Hand Function Test before and after the six-week period, and additional qualitative data were gathered in the form of written evaluations from patients. The quantitative data were analysed using the Mann Whitney U test or Fishers exact test. Themes were highlighted from the qualitative data. The results show that there was a greater difference in the total score of the experimental group using the impaired hand between pre- and post-intervention of 11.8 seconds, compared with 4.3 seconds in the control group, but this was not statistically significant at the 5% level (p=0.06). Additionally, differences in the sub-test scores show a markedly larger improvement in the experimental group. Qualitative data indicate that the experimental group experienced the origami sessions as being enjoyable and beneficial. Further research with a larger sample and randomised group allocation is recommended to verify and expand these preliminary findings.

Spirituality, Occupation and Occupational Therapy Revisited: Ongoing Consideration of the Issues for Occupational Therapists

This opinion piece revisits and considers the spiritual dimensions of occupation and occupational therapy practice. It discusses the dilemmas inherent in such an exploration and suggests ways of looking at different aspects, drawing from some of the literature on this topic. Views are put forward as to whether or not spirituality is a legitimate sphere in which occupational therapists should engage and issues of ongoing debate are highlighted.

Polio survivors’ perceptions of the meaning of quality of life and strategies used to promote participation in everyday activities

The term ‘post‐polio syndrome’ (PPS) is used to describe new and late manifestations of poliomyelitis that occur later in life. Research in this area has focused upon health status rather than its effect on quality of life.

Drawing on Wilcock: An Investigation of the Impact of Her Published Work on Occupational Therapy Practice and Research

Introduction: Ann Wilcocks published work identifies the fundamental importance of occupation in promoting health, wellbeing and even survival. Despite the implications for occupational therapy, the impact of her work has not been comprehensively explored. This research investigated how her ideas were used in published research from 1993 to 2007. Method and findings: Mixed methods obtained two sets of data. First, qualitative data from a textual analysis of Wilcocks published work were analysed and used to create a glossary and a conceptual framework of her ideas. Secondly, content analysis of 48 research papers yielded 121 citations, which were coded into categories. The findings indicated that her ideas did not appear to be embraced fully by other authors and were sometimes applied superficially. Discussion: The conceptual framework was refined and finalised, to demonstrate how Wilcocks ideas are interrelated. It is presented as a means of developing an accessible occupational perspective for research and practice.

Use of the physical environment to support everyday activities for people with dementia: A systematic review

Difficulty with everyday activities is a key symptom and defining feature of dementia, relating to subjective reports of well-being and overall quality of life. One way to support individuals in their daily activities is by modifying the physical environment to make it easier to interact with during activity performance. This systematic review explores the range of studies available using physical environmental strategies to support performance in everyday activities for people with dementia. Seventy-two relevant studies were identified by the search. Physical environmental strategies included changes to the global environment and to architectural features, use of moveable environmental aids and tailored individual approaches. Strategies supported general everyday activity functioning (N = 19), as well as specific activities, particularly mealtimes (N = 15) and orientation in space (N = 16); however, few studies were found that focused on aspects of personal care such as dressing (N = 1) and showering or the preferred hobbies of individuals (N = 0). Overall, there appeared to be a lack of research within private home environments, and of studies which specify the dementia syndrome or the whole neuropsychological profile of people with dementia. More work is needed to extend theoretical understandings of how people with dementia interact with their environments so that these spaces can be designed to further support activities of daily living performance. Future work in this field could also incorporate the perspectives and preferences of those living with dementia.

Therapeutic outcomes in a museum? “You don't get them by aiming for them”. How a focus on arts participation promotes inclusion and well-being

Background The three year “Ways of Seeing” project was hosted by an award-winning museum and included adults with long-term diagnoses associated with mental health and physical impairments. The participants were involved throughout the project, preparing and curating artwork for a major public exhibition. Methods: Qualitative data were collected to explore meanings of the project from the perspective of participants, the project manager and the public, using interviews, participant observation and comment cards. Results: The project was successful in engaging the participants who had previously often felt excluded from mainstream art spaces. Findings about the benefits of arts participation echoed other studies but participants highlighted some difficulty with the ending of the project. Public perceptions were positive, acclaiming the thought-provoking quality of the exhibition. Interviews and participant observation revealed the importance of egalitarian leadership, mutual trust and the absence of any therapeutic agenda. Conclusion: Developing similar projects would offer opportunities to foster diverse artistic communities and empower people with experiences of disability and mental health conditions.