Sirkka-Liisa Ekman

Caregiver singing and background music in dementia care.

Caregiver singing and background music were incorporated into the interaction between caregiver and patient, the aim being to illuminate the meaning of verbal communication between persons with severe dementia and their caregivers. In the absence of music, patients communicated with cognitive and behavioral symptoms associated with dementia. In these situations, caregivers devoted their verbal communication to narrating and explaining their caring activities to the patient. The patient and caregiver, however, had difficulties understanding one another. In the presence of background music, caregivers decreased their verbal instructing and narrating while the patient communicated with an increased understanding of the situation, both verbally and behaviorally. During caregiver singing, a paradoxical effect was observed such that despite an evident reduction in the amount of verbal narration and description by the caregiver, the patient implicitly understood what was happening.

Influence of Caregiver Singing and Background Music on Posture, Movement, and Sensory Awareness in Dementia Care

BACKGROUND AND AIM Previous research suggested caregiver singing could influence persons with severe dementia to communicate with increased competence, to cease aggression, and to cease disruptive screaming, while at the same time they seemed to understand what was going on when being cared for during morning care sessions. The aim of this study was to illuminate the posture, body movements, and sensory awareness of patients with dementia during three types of morning care sessions with professional caregivers: (a) the usual morning care situation, (b) a caring session in which familiar background music was played, and (c) a caring session in which the caregiver sang to and/or with the patient throughout. Nine patients with late-stage dementia and 5 professional caregivers participated in this study, and 27 sessions were videotaped (9 patients x 3 caring situations). DATA COLLECTION AND METHOD: Data collection was done by means of video recording and the data were analyzed using qualitative content analysis. RESULTS During the usual caring situation, patients demonstrated slumped posture, sluggish and asymmetric motion, listlessness, minimal awareness of both egocentric space and the physical environment, and a poor ability to perform to completion activities necessary for personal care. Both background music playing and caregiver singing had strong influences on the body and on sensory awareness. Patients had straightened posture, stronger and more symmetric movements, and a greatly increased awareness of themselves and their environment. Patients appeared to regain skills necessary for daily living, and demonstrated that they could perform tasks with intention, purpose, and competence. Caregiver singing, in particular, was very effective at drawing out capabilities that appeared to be lost in these patients. In addition, caregiver singing elicited a larger degree of mutuality in the interaction between patient and caregiver than was seen with background music. DISCUSSION These results provide further support for the use of caregiver singing in dementia care, and the findings on how caregiver singing can be used to help in dementia caring situations are discussed.

Changes in motor performance in persons with Parkinson's disease after exercise in a mountain area.

&NA; For one week in autumn, over a period of three consecutive years, a total of 12 persons with Parkinsons disease (PD) participated in daily walks of about 4 kilometers in a mountain area in Sweden in order to train rhythm, balance and coordination on the soft heaths. These persons were 60–78 years of age and had been found to be between stage 1 and stage 3 on the Hoehn and Yahr Staging Scale. The aim of the study was to find out whether a week of daily walks in the Swedish mountains would affect the motor performance of persons with PD, objectively and quantitatively assessed by a computer‐assisted, opto‐electronic movement analysis program, the Posturo‐Locomotor‐Manual (PLM) test. As compared with those before the journey, the results showed improved motor performance both immediately after the walking week and also at 3 but not 6 months later. The first year of participation showed the most pro nounced improvements. The results demonstrate a long‐lasting improvement in decreased movement time, indicating enhanced general motor performance and also an improved simultaneous index (SI), indicating a possible effect on the central nervous system. These findings, along with participants narratives about what they did after returning home, may be indicative of strengthened self‐confidence.

An ethnographic study of a day care center for Iranian immigrant seniors.

Late-in-life immigrants are often at risk for psychological stress and social isolation because of language problems, small social networks, and cultural differences from the host society. Community intervention programs can reduce such stress and isolation. In this article, the authors describe a Swedish municipality’s culturally appropriate intervention program for elderly Iranian immigrants based on ethnographic data gathered during a 12 month period. The description includes the activities provided by the program and the experiences of the elderly Iranian immigrants who participate regularly in these activities. The findings document the positive impact of regular participation in the center’s activities on the elders’well-being and health.

Health as continuity and balance in life

Research on immigrant health emphasizes that the elderly are more vulnerable than other age groups in many immigrant populations. This study describes the meanings of health, illness, and disease for Iranian elderly immigrants in Sweden and their relationships with life disruptions. Analysis of interviews using an interpretive-phenomenological method illustrates that the participants experience health as continuity and balance in life. Any disruption of this balance creates a sense of illness that is only partially related to the emergence of disease. Participants did not view health and disease as polarized. Rather, disease is just one component among many that may disrupt the experience of health. Health is perceived as a sense of well-being, can be achieved in spite of disease, and can be disrupted even in the absence of disease. This description of the meaning of health, disease, and illness contrasts with the Western biomedical perspective and is similar in its holism to various non-Western medical systems and complementary approaches. This knowledge can foster more culturally sensitive care.

A Sociocultural Health Model for Late-in-Life Immigrants

This study develops a sociocultural health and illness model for Iranian late-in-life immigrants in Sweden by analyzing ways in which they perceive, experience, and explain their health situations. Fifteen Iranian immigrants, ages 55 to 80, were interviewed; data were analyzed using the interpretive-phenomenology method. The interviews revealed the following concepts: Reflections on the meaning of health were interpreted as cultural understanding of health. Reflections expressing knowledge about preventing illness and maintaining health were interpreted as proposed strategies and beliefs. Reflections expressing how to prevent illness and maintain health were interpreted as practical strategies, which were based on understanding of cultures and were contingent on immigration. Health care providers might use the resulting model to assist patients and families in appropriating cures and symptom management to support patients’ sense of well-being.

‘Music-therapeutic caregiving’: The necessity of active music-making in clinical care

Music’s utility in clinical and caregiving situations is well established in the research literature. Music has been used in numerous medical contexts: (a) for controlling postoperative pain (Broscious, 1999), (b) for reducing nausea and vomiting after chemotherapy (Ezzone et al., 1998), (c) in handling restrained patients (Janelli & Kanski, 1997), and (d) in decreasing anxiety during ventilatory assistance (Chlan, 1998), to name just a few. However, these studies have focused almost exclusively on the use of background music;music’s principal function in caregiving situations consists of modifying the sound environment of the patient. This is in contrast to many forms of music therapy, where active music-making comprises a significant component of the therapeutic process (e.g., Nordoff & Robbins, 1977; Bruscia, 1987; Aldridge, 1996). However, music therapy occurs outside the context of most of the clinical and caring activities mentioned above. What is crucially missing is a form of active music-making – and most especially singing – on the part of caregivers in caring contexts. This is a highly neglected area of consideration, one that has a tremendous but untapped potential to be used as an adjunct to both music therapy and background music to improve the care and functioning of patients. Despite an abundance of anecdotal evidence suggesting that singing can be an effective intervention by many types of caregivers for many types of patients, it is difficult to find any mention of this topic in the literature, a notable exception being the work of Clair (Hanser & Clair, 1995; Clair, 1996a,b; Clair & Ebberts, 1997). We introduce a new term here, music-therapeutic caregiving (MTC), to describe an active form of music-making by caregivers to and/or with patients during the course of actual caregiving activities. The goal for the patient in such a process is not the performance of music but the performance of a host of activities important for daily living and personal health. While MTC may certainly involve singing on the part of the patient, its major focus is on “receptive singing,” in other words, patient responsiveness to caregiver singing and the resultant effect this has on compliance, cognition, and emotion. We will proceed by providing a brief case study of the use of MTC in dementia care, followed by a description of its general features. MTC is an extremely straightforward technique, one that can greatly increase the quality not only of patient care but the caregiver-patient relationship as well.

Two studies of the new nursing education in Sweden: 1. The place of gerontology and geriatrics 2. Student characteristics and expectations

In the autumn of 1993, a new system of nursing education started in Sweden. A questionnaire was sent to the presidents of all the colleges of nursing, health and the caring sciences, and questions were asked about the part played by gerontology and geriatrics in the new curricula. The responses showed a considerable variety in the amounts of theoretical and clinical education given at the colleges. During the first or second week of their education, the students admitted to three colleges in the Mälaren area answered a questionnaire containing questions about their educational backgrounds, their working experiences in the health care system, why they chose nursing education, their ideas of the tasks that a registered nurse primarily carries out, and their preferences for work after graduation. The result shows a correlation between working experience and the reasons for studies. The students stated a preference for working in emergency care rather than in geriatric care after graduation from college.

Life experiences after stroke among Iranian stroke survivors

BACKGROUND Stroke is a major cause of disability worldwide. It is a life-threatening and life-altering event, which leaves many physical and mental disabilities, thus creating major social and economic burdens. Experiencing a stroke and its aftermath can be devastating for patients and their families. In Iran, many services are not available for those who lack property; this may result in many difficulties and long-term problems for stroke survivors and their family members who are usually the main caregivers in Iranian cultural. Despite its effect on their lives, little is known about how the survivors perceive stroke in the Iranian context, therefore, knowing more about this process may enhance problem identification and problem solving. AIM To illuminate how stroke survivors experience and perceive life after stroke. METHOD A grounded theory approach was recruited using semi-structured interviews with 10 stroke survivors. FINDINGS The survivors perceived that inadequate social and financial support, lack of an educational plan, lack of access to rehabilitative services, physical and psychological problems led them to functional disturbances, poor socio-economical situation and life disintegration. The core concept of life after stroke was functional disturbances. CONCLUSIONS The study shows the need to support the stroke survivors in their coping process with their new situation by providing appropriate discharge plans, social and financial support, social insurances and training programmes for the stroke survivors and their families.

Health Care Experiences and Beliefs of Elderly Finnish Immigrants in Sweden

Purpose: To elucidate the experiences and beliefs of care of elderly Finnish immigrants living in Sweden (Sweden-Finns) in order to gain an understanding of the role ethnic back-ground plays in these experiences and beliefs. Design: 39 elderly Sweden-Finns living in Stockholm were interviewed. The data were analysed hermeneutically. Results: On a surface level, the care in Sweden was culturally congruent to elderly Sweden-Finns’ experiences and beliefs of care. However, care in Finland and the care providers with Finnish background were regarded as superior to Swedish caregivers, giving a deeper sense of familiarity and trust in anticipation of good care. Implications for practice: Culturally appropriate care with care providers sharing the same ethnic background is important for ethnic elderly persons in enabling familiarity and trust between staff and patients.