Approaching the end of life and dying with dementia in care homes : the accounts of family carers.

Research into end of life and dying with dementia in care homes from the family carer's perspective is limited. From the available evidence, it appears that family carers find themselves in an unfamiliar situation about which they lack knowledge and experience. Whilst dementia tends not to be acknowledged as a terminal illness by many family carers, they are expected to make end of life decisions on behalf of their relatives. Family carer decision-making is underpinned by values of quality of life, previously expressed wishes, comfort provision and dignity preservation. This is often approached when family carers are grieving for the anticipated loss of their relative and have their own personal needs that require to be addressed. Within a care home setting, a curative care–palliative care split is unhelpful in resolving these tensions and a model of comprehensive care appears a more appropriate approach. This requires ongoing communication between the person with dementia, family members and professionals from the early stages of the condition

Living with early-stage dementia: a review of qualitative studies

A

Ensiled Maize and Whole Crop Wheat Forages for Beef and Dairy Cattle: Effects on Animal Performance

Key points Maize silage can be produced and fed to beef and dairy cattle at a similar price to grazed grass. Including maize silage in the diet increases feed intake and performance of beef and dairy cattle. The optimum stage of maturity at harvest for increased performance is at a dry matter concentration of approximately 300 g/kg. Including maize silage in grass silage-based diets has a concentrate sparing effect of up to 5 kg/cow/d. There is a negative relationship between stage of maturity at harvest and milk fat concentration. Whole crop wheat can be produced and fed at a similar cost to grass silage. Including whole crop wheat either fermented, urea- or alkalage-treated in grass silage-based diets increases feed intake but does not alter performance of beef or dairy cattle

From conversation to connection: a cross case analysis of life story work with five couples where one partner has semantic dementia

Semantic dementia causes progressive communication difficulties that significantly impact on the person and their family. There is a paucity of research examining conversation skills in this condition and associated interventions to support interaction, such as life-story work. This study used a multiple case study design to: (a) explore the everyday conversation experiences of five individuals with semantic dementia and their spouses; and (b) examine how intervention using interaction-focused life-story work could support communication needs. A total of 74 home visits were conducted over a longitudinal period. An innovative combination of conversation analysis of video and audio data alongside biographical interviewing was used. Information derived from these strands was utilised to design an individually tailored life-story intervention. Cross-case analysis examined the contribution of life-story work to interaction and other aspects of care. Results showed that a range of challenges and skills were present within conversation. Life-story work was delivered in all cases using a variety of formats and the work could be conceptualised under various points of connection: interactional, emotional, new, practical and future. Detailed assessment was important to define aims for intervention and appropriate format(s) for life-story work for the individual concerned. Outcomes for communication in this study were not solely about supporting the telling of facts about the person's life but represented a broader focus to facilitate embodied and emotional connections. This study demonstrates that creativity within life-story work is important to foster social interaction, beyond information exchange, using both verbal and non-verbal behaviours. In addition, video data show promise for exploring in-the-moment outcomes for research and practice, particularly to capture the non-verbal dimensions of this work

Everyday conversation in dementia: a review of the literature to inform research and practice

Background: There has been increasing interest in dementia care in recent years, including how practitioners, service providers and society in general can help individuals to live well with the condition. An important aspect to this is provision of advice to ensure conversation partners effectively support the person with dementia in conversation. Aims: To provide a descriptive review of the literature examining everyday conversation in dementia in order to inform practice and research. Methods & Procedures: This review used a method specifically developed for reviewing conversation analytic and related literature. A range of databases were searched using key words and explicitly described inclusion criteria leading to a final corpus of 50 titles. Using this qualitative methodology, each paper was examined and data extracted. The contribution of each of these is described and the implications for practice and research are outlined. Main Contribution: This review examined studies into conversation in Alzheimer's disease, vascular dementia and Lewy body dementia, grouping these into: early influential studies; work drawing on positioning theory; studies using social and linguistic approaches; collaborative storytelling; formulaic language; studies specifically using conversation analysis; and conversation as a target for individualized therapy. In addition, more recent work examining primary progressive aphasia and behavioural variant frontotemporal dementia was explored. Overall, this review indicates that research examining conversation in natural settings provides a rich source of data to explore not just the challenges within conversation for those taking part, but also the skills retained by the person with dementia. An important aspect of this understanding is the notion that these skills relate not only to information exchange but also aspects of social interaction. The role of others in scaffolding the conversation abilities of the person with dementia and the potential of this for developing interventions are discussed. Conclusions & Implications: The review indicates that interventions targeting conversation in dementia are often advocated in the literature but currently such approaches remain to be systematically evaluated. In addition, many of the important insights arising from these studies have yet to inform multidisciplinary dementia care practice

Life story resources in dementia care: a review.

PURPOSE: Life story work has a relatively long tradition in the caring sciences and is recognised as an important component of dementia care and practice. However, to date, there has not been a review of accessible life story resources. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: Following a systematic approach to identification and inclusion, 11 life story resources were reviewed to ascertain areas of commonality and divergence between the materials. FINDINGS: The authors were able to group the analysis under eight areas and at the end of this process, it was uncertain if life story work is a formal staff intervention or an informal activity that people with dementia and their families could engage in. Resources also varied in terms of whether the life story information was organised in a chronological way, or with topics of interest/discussion or with a combination of both. Life story evaluation and its impact on the life of the person with dementia is in need of development. PRACTICAL IMPLICATIONS: Across the resources the authors identified four reasons to do life story work which the authors have named as: emotional connections; interactional connections; building new connections and practical care connections. SOCIAL IMPLICATIONS: There was limited guidance aimed at helping people with dementia to develop and compile their own life story. ORIGINALITY/VALUE: This paper provides new insights into the usefulness, future directions and content of life story resources in dementia care. It will be of interest to those in health and social care as well as people living with dementia

An Evaluation of Grain Processing and Storage Method, and Feed Level on the Performance and Meat Quality of Beef Cattle Offered Two Contrasting Grass Silages

Traditionally cereals have been dried or treated with propionic acid and processed prior to feeding to finishing beef cattle. Recently new techniques have been developed for storing and feeding grain to beef cattle. The objective of the current study was to evaluate the effects of grain storage and processing method, and grain feed level on performance and meat quality of beef cattle offered two contrasting feed value grass silages

Microscale Effects from Global Hot Plasma Imagery

We have used a three-dimensional model of recovery phase storm hot plasmas to explore the signatures of pitch angle distributions (PADS) in global fast atom imagery of the magnetosphere. The model computes mass, energy, and position-dependent PADs based on drift effects, charge exchange losses, and Coulomb drag. The hot plasma PAD strongly influences both the storm current system carried by the hot plasma and its time evolution. In turn, the PAD is strongly influenced by plasma waves through pitch angle diffusion, a microscale effect. We report the first simulated neutral atom images that account for anisotropic PADs within the hot plasma. They exhibit spatial distribution features that correspond directly to the PADs along the lines of sight. We investigate the use of image brightness distributions along tangent-shell field lines to infer equatorial PADS. In tangent-shell regions with minimal spatial gradients, reasonably accurate PADs are inferred from simulated images. They demonstrate the importance of modeling PADs for image inversion and show that comparisons of models with real storm plasma images will reveal the global effects of these microscale processes