Ulla Lundh

‘We do things together’: A case study of ‘couplehood’ in dementia

The value of the single case study is well established in dementia care with the seminal contributions of Alzheimer and Kitwood being based on the study of individuals. This article presents a case study of an elderly married couple living with dementia and explores how their relationship has continued to flourish. In drawing on their story we highlight ways in which both partners seek to ‘maintain involvement’ of the person with dementia (PWD) (Keady, 1999), and consider the various types of ‘work’ that is required. We suggest that whilst the ‘personhood’ of the PWD as an individual has received much recent attention, a consideration of ‘couplehood’ is also essential to a full understanding of how spouses live with and respond to the impact of dementia.

Awareness context theory and the dynamics of dementia Improving understanding using emergent fit

This article presents the initial results of an ongoing constructivist grounded theory study (Charmaz, 2000) exploring the impact of dementia on the everyday life and relationships of older spousal couples. Using a process of ‘emergent fit’ (Glaser, 1978) and drawing upon data from 74 interviews with 20 spouse couples living with dementia, it considers the relevance of ‘awareness context theory’ (Glaser & Strauss, 1965) and the ‘dynamics of dementia’ (Keady, 1999) to an understanding of interpersonal relationships among spouses. The combination of existing literature and new data provide further insights into how couples actively work to ‘construct’ awareness in a way that, for the majority, maintains both a sense of ‘self’ for the person with dementia (PWD) and the integrity of the relationship between couples. It is suggested that a ‘mutual acknowledgement’ of the diagnosis and a subsequent focus on maintaining a meaningful life in the present combine to create a ‘nurturative relational context’ in which living with dementia unfolds.

'Entering a New World': empathic awareness as the key to positive family/staff relationships in care homes.

Despite an almost universal policy of community care, placing a relative in a care home will be an increasingly common event as population ageing continues. Studies suggest that most families wish to remain involved in care following placement but that they often experience difficulties in establishing relationships with staff. This paper reports on the fifth phase of a Swedish study exploring the experience of placement from a temporal perspective and including the views of all the key actors (relatives, staff in the community, staff in care homes). The focus here is placed on the perceptions of care home staff and their perceived role in relation to spouses who have recently placed a partner. The study adopted a grounded theory approach and data were collected from in-depth interviews with 16 staff members of varying grades and positions. Analysis of the data suggested 3 levels of awareness amongst staff: empathic awareness, guarded awareness and limited awareness. The characteristics of empathic awareness are outlined and its implications briefly considered.

Moving into a care home: the role of adult children in the placement process

Admission of an older person to a care home is widely recognised as a very stressful period for the family and one which, despite community care policy, is likely to be an increasingly common experience. Although there is a growing research base in this area, there have been few studies on the role of adult children in supporting their parents during this difficult transition. This paper reports on the third stage of a grounded theory study conducted in Sweden which explored the part played by adult children in the placement process. Data were collected from 13 adult children using in-depth semi-structured interviews and the results are compared with themes previously derived from interviews with 26 spouse carers. The analysis reveals important overlaps and differences and suggests the need for further research exploring the dynamics of the placement process.