Mary Pat Sullivan

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.

Look after yourself: active ageing, individual responsibility and the decline of social work with older people in the UK

The idea of active ageing retains a broad appeal and has a global reach, particularly through the influence of the World Health Organisation (WHO). However, in practice it has been the subject of criticism. In this article, it is argued that the incorporation of active ageing into the policy agendas of the welfare systems for older people should be understood by reference to the perceived effects of demographic trends on demand for services. In the context of the British welfare system, the active ageing agenda has become inextricably linked with the broader policy agenda to reduce older peoples call on public resources in order to manage the increasing proportions of older people in the British population. The implications of these developments for social work are significant.

Facilitating the development of social work in the Hashemite Kingdom of Jordan A collaboration between Jordan and the UK

English This article reports on a collaboration between Jordan and the UK to develop social work as a profession in Jordan. Reflecting on some of the less anticipated outcomes of the project and the mutual benefits of engaging with cross-cultural alliances, the article is contextualized within debates around post-colonialism and the indigenization of practice. French Cet article présente une collaboration jordano-britannique visant le développement de la profession du travail social en Jordanie. Il apporte une réflexion sur certains des résultats les plus inattendus du projet ainsi que sur les bienfaits retirés de part et d’autre de cette alliance interculturelle. La présente réflexion se situe dans le contexte d’un débat touchant le post-colonialisme et l’adaptation des pratiques aux différents milieux d’exercice. Spanish Se informa sobre una colaboración entre Jordania y el Reino Unido en el desarrollo profesional del trabajo social. Se reflexiona sobre algunas consecuencias del proyecto que no fueron anticipadas, así como los beneficios mutuos de crear alianzas culturales. El ensayo toma en consideración el contexto de los debates acerca del post-colonialismo y las prácticas indígenas.

Transnational collaboration: Evaluation of a social work training workshop in Jordan

This article presents an evaluation of a training workshop on developing social work in Jordan. Literature on transnational collaboration provided a context for the initiative.The evaluation outcomes highlight the transition from informal support to the need for a more structured professional response to social problems.

Professionalising social work in the Hashemite Kingdom of Jordan: processes and implications

This paper critically discusses the development of social work in Jordan. It introduces a range of social, cultural and political circumstances in Jordan, and the consequent strategies adopted in the process towards the professionalisation of social work and the growth of social work interventions with individuals, families and communities. The paper also considers lessons learned and some of the implications of professionalising social work that are also relevant for other human services engaged in international development.

Dancing with loneliness in later life: A pilot study mapping seasonal variations

This article reviews the extant research literature on loneliness and peer victimization for children and youth, and explores the complex relationship between these two constructs. While lonely students who have few friends and receive limited peer support are vulnerable to being victimized by their peers, loneliness also emerges as a salient outcome of persistent and chronic peer victimization. The author discusses the phenomenon and incidence of bullying, the predictors of bullying and loneliness in children and youth, and reviews the literature associated with peer victimization in children and youth with disabilities, a population that is particularly vulnerable to being both the perpetrator and victim of bullying. The article concludes with a review of school-based intervention approaches to alleviate bullying in children and youth.Temporal variations in loneliness at the individual and population level have long been reported in longitudinal studies. Although the evidence is limited due to methodological distinctions among studies, we broadly know that loneliness as one ages is a dynamic experience with people becoming more or less lonely or staying the same over time. There is, however, less evidence to understand individual variations in loneliness over shorter periods of time. This paper reports on one element of a small mixed method pilot study to investigate seasonal variations in loneliness over the course of one year and to test the effectiveness of tools used to collect data at repeated short intervals. Our findings confirm that loneliness is dynamic even over shorter periods of time with participants reporting to be lonelier in the evenings, weekends and spring-summer period. Data measures were at times problematic due to language and/or interpretation and reinforce the relevance of reviewing the more common approaches to studying loneliness to more effectively capture the complex and individual nature of the experience.

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.

‘Because my brain isn’t as active as it should be, my eyes don’t always see’: a qualitative exploration of the stress process for those living with posterior cortical atrophy

Objectives To explore the stress process for individuals living with posterior cortical atrophy (PCA) and their families. Design A qualitative study using in-depth semi-structured dyadic and individual interviews with people living with a diagnosis of PCA and a family carer. Interview transcripts were thematically analysed. Setting Participants’ homes. Participants 20 individuals in the mild to moderate stages of PCA and 20 family carers. Findings Three major themes were identified: (1) the diagnostic journey: mostly an unsettling and convoluted process, owing to the early age of onset, rarity and atypical symptom profile of PCA. (2) Interactions with the physical environment: profound difficulties with functional and leisure activities were usually compensated for with adaptations maximising familiarity or simplicity. (3) Implications within the psychosocial environment: symptoms impacted individuals’ sense of independence and identity and required reallocations of roles and responsibilities. Ongoing uncertainties and the progressive nature of PCA caused most dyads to take a ‘one day at a time’ approach to coping. Relatively well-preserved insight and memory were a benefit and burden, as individuals shared the illness experience with family members and also compared their current situation to pre-diagnosis. The experience was framed by background and contextual factors and understood within an ever-changing temporal context. Conclusion The stress process in PCA is characterised by uncertainty and unpredictability from diagnosis through to ongoing management. The provision of tailored information about cortical visual problems and associated functional difficulties, time-sensitive environmental adaptations to help those with PCA to identify what and where things are and psychosocial interventions for the marital/family unit as a whole would be useful to improve both functional status and psychological well-being. Future research exploring (1) stress and coping in the later stages of PCA and (2) the nature and impact of visual impairment(s) in typical Alzheimer’s disease would be worthwhile.

IS THIS MY HOUSE? UNDERSTANDING THE IMPACT OF DEMENTIA-RELATED VISUAL IMPAIRMENT WITHIN THE HOME ENVIRONMENT

income and number of assets). We also estimate a combined PAF, and adjusted combined PAF to account for the non-independence of the risk factors in order to provide more conservative estimates of the proportion of incidence disability cases attributable to depression and dementia. Results:From a sample without severe disability at baseline, the prevalence of depression at baseline was 24.2% (95% CI: 22.2-26.3), and for dementia was 5.4 % (95% CI: 4.4-6.6). Rate or incidence of severe disability among people with dementia at baseline was 167.27 per 1000 person years (py) (CI 95%: 118.90-235.30), and among people with depression at baseline was 71.26 py (CI 56.3890.07). Non-adjusted contribution of dementia and depression to disability was 4.2% (95% CI: 3.1-5.2) and 11.4% (95% CI: 6.9-15.7), respectively. The combined PAF for both mental conditions was 15.1% (95% CI: 9.8-20.1), and the adjusted combined PAF was 9.9% (95% CI: 6.5-13.1). Conclusions: Conservative estimates showed that depression and dementia together account for nearly 10% of severe disability in Mexican elders. It is necessary to recognize mental illnesses is an important component to pay attention in the public health approach of older adults.

STRESS PATHWAYS FOR PEOPLE WITH POSTERIOR CORTICAL ATROPHY AND THEIR CARERS

examined the knowledge and attitude about dementia among a Bangladeshi community in England. In this context, it is vital that future study highlights the importance of raising dementia awareness and provides more information to Bangladeshi community members about dementia, dementia caregiving as well as religiously sensitive healthcare services. Female 0.95 (0.64-1.42) 0.808 1.05 (0.62-1.77) 0.865 Social Support 0.88 (0.86-0.91) <0.001 0.91 (0.87-0.95) <0.001 Screened Positive for dementia 0.92 (0.44-1.90) 0.818 1.11 (0.47-2.60) 0.814