Emotional well-being in people with sight loss: Lessons from the grey literature

Literature that is not peer-reviewed and distributed through a publisher is known as ‘grey’. As it is used to inform policy and practice we reviewed the grey literature concerning emotional well-being in people with sight loss. We consulted and searched the websites of UK voluntary organizations, and scanned reference lists of previous reviews for reports available from 2001 to 2008. We summarized 24 studies in two sections: observations that assessed psychosocial well-being or demand for support services (n = 15); and evaluations of interventions that aimed to improve emotional well-being (n = 9). Observations showed that people with sight loss can report low emotional well-being, but their statistical and clinical significance requires testing. Interventions showed promise for counselling but also require further evaluation. We encourage service providers and researchers to collaborate and produce high quality research to more persuasively inform policy and practice

A new approach to fear of falls from connections with the post-traumatic stress disorder literature

Fear of falling (FoF) is as an important psychological problem amongst older people. While it has been researched for around four decades, paradoxically there is no agreed definition of FoF. Confusion over the definition of fear of falling inhibits current understanding of empirical findings. The objective of this paper is to critique current definitions of FoF and to present a novel theoretical model that aims to resolve theoretical misunderstanding. A narrative review was conducted to present definitions of FoF and concepts often conflated with it including fall-related self-efficacy and anxiety. Then, by drawing on posttraumatic stress disorder (PTSD) theory and research, we present clear distinctions between the concepts. We argue that the presence or absence of anxiety determines whether FoF becomes maladaptive or adaptive respectively, and that enhancing self-efficacy is key to optimizing post-fall psychological recovery. The theoretical clarity presented will aid future research and application of evidence to the benefit older people

Meaningful activities for improving the wellbeing of people with dementia: Beyond mere pleasure to meeting fundamental psychological needs

Aims: Dementia is being increasingly recognised as a major public health issue for our ageing populations. A critical aspect of supporting people with dementia is facilitating their participation in meaningful activities. However, research to date has not drawn on theories of ageing from developmental psychology that would help undergird the importance of such meaningful activity. For the first time, we connect existing activity provision for people with dementia with developmental psychology theories of ageing. Method: We reviewed the literature in two stages: First, we narratively searched the literature to demonstrate the relevance of psychological theories of ageing for provision of meaningful activities for people with dementia, and in particular focused on the stage-based theories of adult development (Carl Jung and Erik Erikson), gerotranscendence (Tornstam), selective optimisation with compensation (Baltes and Baltes), and optimisation in primary and secondary control (Heckhausen and Schulz). Second, we systematically searched PubMed and PsycINFO for studies with people with dementia that made use of the aforementioned theories. Results: The narrative review highlights that activity provision for people with dementia goes beyond mere pleasure to meeting fundamental psychological needs. More specifically, that: life review therapy and life story work addresses the need for life review; spiritual / religious activities addresses the need for death preparation; intergenerational activities addresses the need for intergenerational relationships; re-acquaintance with previously-conducted leisure activities addresses the need for a sense of control and to achieve life goals; and pursuit of new leisure activities addresses the need to be creative. The systematic searches identified two studies that demonstrated the utility of applying Erikson’s theory of psychosocial development to dementia care. Conclusions: We argue for the importance of activity provision for people with dementia to help promote wellbeing amongst an increasing proportion of older people

Social care and support needs of community-dwelling people with dementia and concurrent visual impairment

Objectives: Little is known about the needs of people who have both dementia and visual impairment. This study explored the social care and support needs of people with dementia and concurrent visual impairment, and the barriers and facilitators for meeting these needs. Method: Twenty-six semi-structured interviews were conducted: 21 joint interviews with the person with dementia and visual impairment and their family member / paid carer; and 5 individual interviews with either the person with dementia and visual impairment (n=4) or their family member (n=1). Interviews were audio recorded, transcribed verbatim, and analysed thematically. Results: Three themes are presented. (1) Social care needs: having dementia can reduce an individual’s ability to cope with their visual impairment, and in turn make the person more dependent and prone to lack of daily stimulation. (2) Barriers to using technology to meet social care needs: difficulties were reported in learning to use unfamiliar technology, and for some, the presence of dementia made visual impairment aids unusable and vice versa. Visual impairment aids were also perceived as expensive. (3) Familiarity as a facilitator for meeting social care needs: living at home or taking furnishings and ornaments into a new home environment facilitated retention of independence, and continuity of paid carers / volunteers facilitated the caring relationship between the individual and staff / volunteer. Conclusion: Dementia and visual impairment often coexist and care workers will better serve older people if they are aware of the social care and support needs that arise from having both conditions

Can a systems approach reduce adverse outcomes in patients with dementia in acute settings? (innovative practice)

People with dementia experience adverse outcomes such as pressure sores during their stay in acute hospitals. The application of a systems approach in an acute setting places an emphasis on the patient’s journey in addition to the organisational factors that are present within a hospital context. This article draws upon principles obtained from a theoretical model, which was extracted from the work of Edwards (1972), Hawkins (1987) and Zecevic et al. (2007), in order to illustrate how the application of a novel systems approach (human interaction, environment, equipment and policy) could be used in acute hospital settings to reduce adverse health outcomes by using an imaginary patient with dementia

Association between the instrumented timed up and go test and cognitive function, fear of falling and quality of life in community dwelling people with dementia

Objective To explore relationships between the instrumented timed up and go test (iTUG) and the following risk factors for falls: cognitive functioning, fear of falling (FoF), and quality of life (QoL) in people with dementia. Methods 83 community-dwelling older adults with dementia (mean±sd age 78.00±7.96 years; 60.2% male) completed an interview to capture global cognition (Mini-Addenbrooke’s Cognitive Evaluation), FoF (Iconographical Falls Efficacy Scale) and QoL (ICEpopCAPability measure for Older people). Participants completed an iTUG whilst wearing an inertial sensor on their trunk. Linear accelerations and rotational velocities demarcated sub-phases of the iTUG. Relationships were explored through correlations and regression modelling. Results Cognition was related to duration of walking sub-phases and total time to complete iTUG (r = 0.25-0.28) suggesting gait speed was related to cognition. FoF was most strongly related to turning velocity (r = 0.39-0.44), but also to sit-to-stand, gait sub-phases and total time to complete iTUG. Sub-phases explained 27% of the variance in FoF. There were no correlations between iTUG and QoL. Conclusions Cognition and FoF were related to time to complete walking sub-phases but FoF was more closely related to turning velocity and standing acceleration. iTUG may offer unique insights into motor behaviour in people with dementia

Experiences of rural life among community-dwelling older men with dementia and their implications for social inclusion

Current international dementia care policies focus on creating ‘dementiafriendly’ communities that aim to support the social inclusion of people with dementia. Although it is known that the geo-socio-cultural rural environment can impact on the experiences of people living with dementia, this can be overlooked when exploring and implementing social inclusion policies. This paper addresses an important gap in the literature by exploring the perceptions of daily life for older men (65+ years) living with dementia in three rural areas of England. Open interviews were conducted with 17 rural-dwelling older men with dementia and the data elicited were analysed thematically to construct two higher order themes. The first focussed on ‘Cracking on with life in a rural idyll’ and highlighted the benefits of rural living including the pleasant, natural environment, supportive informal networks and some accessible formal dementia support. The second presented ‘A challenge to the idyll’ and outlined difficulties the men faced including a lack of dementia awareness amongst their family and the wider rural community as well as physical and internal motivational barriers associated with the rural landscape and their dementia. The findings were interpreted through a lens of social inclusion and demonstrated how the geo-socio-cultural rural environment both enabled and inhibited facets of the men’s experiences of life in their communities. Based on these findings, the paper offers recommendations for practitioners, researchers and policy makers wishing to promote social inclusion in rural-dwelling older men living with dementia