Assimilation of problematic voices within psychotherapeutic work with people with dementia

This paper presents an outline of how the Assimilation of Problematic Voices model (APV) can be used as a framework to understand change in awareness of people with dementia. APV is a dialogical model of change developed within psychotherapy process research. Within this framework, the concept of dementia can be understood as being psychologically problematic for people affected by the illness in the sense that the existential threat of dementia prevents an easy assimilation into the person’s existing self-concept. Successful assimilation is viewed as the result of a process that involves a series of conversations between a Dominant Voice, typically asserting a continuation of the status quo, and a Problematic Voice or voices which articulates emotionally difficult material. This process of assimilation is illustrated through accounts given by people with dementia about their illness within psychotherapy groups run by the author. Representing the accounts of people with dementia in this way is important as it enables a fine grained analysis of changes in expressed awareness, including those that occur during psychosocial interventions, such as psychotherapy or counsellin

A feasibility study of translating “Living Well with Dementia” groups into a Primary Care Improving Access to Psychological Therapy service (innovative practice)

© 2016, © The Author(s) 2016. This paper describes the use of the “Living Well with Dementia” or LivDem model of group support for people affected by dementia within a Primary Care setting. Five people affected by dementia and their carers joined a 10-week group, although one man withdrew before the start due to illness. Joint sessions were held on the first and the final meetings, with separate parallel group sessions for people affected by dementia and their carers for the remaining eight sessions. One person affected by dementia and their carer withdrew due to illness before the end of the sessions. A self-report measure of Quality of Life suggested improvements for two of the three people affected by dementia who completed all of the sessions. The proxy ratings of carers indicated improvements for all three participants. Qualitative interviews were carried out with participants and carers to assess their experience of the group. Although both people affected by dementia and their carers found the LivDem intervention helpful, concerns remain about the continued need for support by a Dementia specialist

Feasibility study suggests no impact from protected engagement time on adverse events in mental health wards for older adults

Hospital adverse events, such as falls, violence and aggression, security, self-harm, and suicide, are difficult to manage in older people with dementia. The purpose of the present study was to determine whether protected engagement time (PET) resulted in lower adverse events and incidents compared to comparable non-PET wards for people admitted to inpatient older people's mental health wards. Ten inpatient wards for older people were included. Five followed a PET-management pathway, while five continued usual care. All adverse events and incidents were recorded in routine hospital records over 72 weeks. Data were gathered from these records and analysed as rate per person per week to assess differences in frequency and type of adverse events between wards. A total of 4130 adverse events were recorded. In the PET wards, a mean of 0.38 adverse events occurred per person per week compared to 0.40 in non-PET wards. No statistically-significant differences were found between PET and non-PET wards for adverse events (P = 0.93), or for adverse events of any particular type (P ≥ 0.15). Therefore, there is no evidence to suggest that PET has any impact on adverse events in older people's mental health wards. Further investigation with a larger cohort is warranted, using a definitive, phase 3, clinical trial

Quality of relationships as predictors of outcomes in people with dementia: a systematic review protocol

INTRODUCTION: Serious adverse outcomes for people with dementia include institutionalisation, hospitalisation, death, development of behavioural and psychiatric symptoms, and reduced quality of life. The quality of the relationship between the person with dementia and their informal/family carer is thought to affect the risk of these outcomes. However, little is known about which aspects of relationship quality are important, or how they affect outcomes for people with dementia. METHODS AND ANALYSIS: This will be a systematic review of the literature. Electronic databases MEDLINE, EMBASE, Web of Science, PsycInfo, the Cochrane Database, ALOIS and OpenGrey will be searched from inception. 2 independent reviewers will screen results for eligibility with standardised criteria. Data will be extracted for relevant studies, and information on the associations between relationship quality and dementia outcomes will be synthesised. Meta-analysis will be performed if possible to calculate pooled effect sizes. Narrative synthesis will be performed if study heterogeneity rules out meta-analysis. ETHICS AND DISSEMINATION: Ethical review is not necessary as this review summarises data from previous studies. Results will be disseminated via peer-reviewed publication. Results will also be disseminated to a patient and public involvement group and an expert panel for their views on the findings and implications for future work. TRIAL REGISTRATION NUMBER: CRD42015020518

Does personal experience of dementia change attitudes? The Bristol and South Gloucestershire survey of dementia attitudes

Background: it is unclear how attitudes towards people with dementia are formed and whether, for instance, increased contact with people with dementia, either through work or personal experience alters attitudes. This study used a validated questionnaire (the Approaches to Dementia Questionnaire or ADQ) to examine whether having experience of dementia (either as a result of work, or by being affected by dementia) is associated with differences in attitudes towards dementia.Methods: a modified version of the ADQ was completed by 2,201 participants, either on-line or in written form. Participants also recorded their age, gender and ethnicity as well as whether they worked with people with dementia, or had been personally affected by dementia.Results: increased contact with people with dementia was associated with increases in both total ADQ scores and across both sub-scales reflecting more positive person-centred attitudes toward dementia. The highest levels of increase were found amongst non-white participants.Conclusions: this study is, we believe, the first attempt to look systematically at whether greater contact with people with dementia is associated with changes in attitudes. The results strongly support the contention that increased contact with people with dementia leads to more person-centred attitudes, and by inference, less stigmatising views

Re: An investigation of public attitudes towards dementia in Bristol and South Gloucestershire using an online version of the Approaches to Dementia Questionnaire

Letter accepted for publication in the International Journal of Geriatric Psychiatr

The ADAPT Study: Adapting the dementia care pathway for south Asian families in the UK

The ADAPT study got started because there were so few culturally appropriate dementia resources for South Asian families. Sahdia Parveen and colleagues describe the toolkit created by the study to help families navigate the system

Special education leavers in Central Scotland: a socio psychological perspective

The principal aim of this thesis is to examine the reasons that special education leavers with a mental handicap give for their labelling. The thesis consists of three parts. In the pilot study seven trainees at an Adult Training Centre were interviewed between March and April 1985. Six of these trainees were reinterviewed between November 1986 and January 1987. In the second part of the thesis, the normative study, a survey was carried out which established the employment history of 80 of the 105 leavers from a special school and a special unit between 1982 and 1985. The normative study also established that at least 35 of the 60 leavers on whom it was possible to gather information had been the victims of informal labelling. In the final part of the thesis, the ipsative study, eleven special school and special unit pupils were interviewed. The first interviews were carried out in the term before the participants left school in 1985. The final interviews were conducted at the end of the participants’ first year after leaving school, in January 1987. I argue that the leavers that I interviewed actively interpreted labelling and produced often quite detailed and complex explanations. For the leavers these explanations served the function of limiting the extent to which they were personally responsible for their placement in a special school or a special unit

Personal message cards: An evaluation of an alternative method of delivering simulated presence therapy

© 2015, © The Author(s) 2015. Simulated presence therapy is a technique which utilises a familiar recorded voice to calm and reassure people with dementia who are agitated or anxious. Although simulated presence therapy has shown potential benefits in small-scale studies, practical limitations in making and playing the recordings have restricted its use. An alternative method of delivering a message from an attachment figure is through a personal message card. This was one of seven products used within the Bath Memory Technology Library which was made available free of charge to people affected by dementia and their carers. This paper provides an evaluation of the personal message cards. Although feedback was received on only 10 of the 24 cards that were distributed, for nine people there was evidence that the cards met the goals that had been set either fully or in part, and that people affected by even quite severe levels of dementia could benefit from them

The paradox of dementia: Changes in assimilation after receiving a diagnosis of dementia

© 2014, © The Author(s) 2014. This qualitative study used semi-structured interviews to explore how six people talked about their difficulties before and after a dementia diagnosis. Participants’ accounts of their memory problems were analysed in terms of the verbal Markers of Assimilation of Problematic Voices Scale. This analysis indicated that after diagnosis some participants were able to integrate aspects of their illness that had previously been too painful, and which had been warded off. The process by which individuals were able to integrate a dementia diagnosis into their sense of self-involved stepping in and out of awareness, with both acceptance and denial featuring in their accounts as they approached and then retreated from addressing the diagnosis. In contrast, other participants resisted moving towards explicitly acknowledging their dementia but were instead able to express concerns about what this movement would entail, for instance voicing their fears that it would mean that they had surrendered. Social support seems to have been crucial in enabling participants to sustain a positive sense of self in the face of this adjustment