• Driving and dementia: DVLA guidelines?

      Bouman, Walter P.; Johnson, Hazel (1996)
    • Destination and dependency of psychogeriatric inpatients at discharge from Nottingham hospitals following the 1990 NHS and Community Care Act

      Page, Kim; Blagden, Karen; Biswas, Asit (1996)
      This study examines the impact of the National Health Service (NHS) and Community Care Act on the discharge of patients from inpatient psychogeriatric wards in Nottingham. All inpatients discharged from five psychogeriatric acute assessment wards between April 1 and September 30, 1993 were included in the study. The dependency ofeach patient was assessed using the balance of care method and relationships between dependency and destination at discharge were examined. The dependency status of patients discharged between April 1993 and September 1993 was compared with the dependency and destination at discharge of all inpatients admitted during the corresponding period in the previous year. There was a larger proportion of high-dependency patients admitted in 1993 than in 1992. There was no difference between the two periods in the median length of stay. No association was found between length of stay and dependency, nor between dependency status and destination at discharge. The first 6 months of the implementation of the Act has had negligible impact on discharge activity in these wards as measured by length of stay and destination at discharge.
    • Cognitive impairment associated with lamotrigine

      Bouman, Walter P. (1997)
      Presents the case of a 69-yr-old woman with a 10-yr history of epilepsy and alcohol-induced dementia, whose epilepsy had been well controlled for 2 yrs with valproate 1,000 mg and lamotrigine 100 mg. She was admitted for assessment because of a gradual deterioration in her cognitive state and functional level over a 6-mo period. After discontinuation of lamotrigine, she became more communicative with clear improvement in cognition and a steady gait. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Determinants of satisfaction with care and emotional distress among informal carers of demented and non-demented elderly patients

      Mafullul, Yakubu M. (2000)
      Little research has been carried out into determinants of both carer satisfaction in the caregiving role and how these compare with determinants of emotional distress among carers. Principal informal caregivers to 91 patients with dementing or non-dementing disorders were identified from consecutive referrals to community psychiatric nurses in an old age psychiatry service. Clinical, demographic, service and carer satisfaction variables were recorded. Emotional distress in carers was measured with the 28 item General Health Questionnaire. Dissatisfaction with caregiving was weakly correlated with emotional distress (r=0.21, p=0.042). Multiple linear regression revealed two variables which were associated with greater dissatisfaction with the caregiving role, the carers' overall rating of the degree of difficulty in the caregiving role (p<0.001) and younger age of the carer (p=0.014). Emotional distress was independently associated with the degree of difficulty in the caregiving situation (p<0.001) and inversely with the dependency of the patient on the care (p=0.038). The caregiver's assessment of the difficulty in caregiving was associated with both carer dissatisfaction and emotional distress in the caregiving role. While emotional distress was associated with the perception that the patient could do more for themselves, carer dissatisfaction was associated with younger age of the carer. There were competing demands on younger carers, particularly work.Copyright 2000 John Wiley & Sons, Ltd.
    • On telling the truth in Alzheimer's disease: A pilot study of current practice and attitudes

      Johnson, Hazel; Bouman, Walter P.; Pinner, Gill (2000)
      Research suggests there has been a cultural change in the disclosure of diagnosis; most evidence relates to cancer and there is little knowledge of attitudes towards disclosing the diagnosis of Alzheimer's disease. A questionnaire was used to survey the current practice and attitudes of old- age psychiatrists and geriatricians in Nottingham, UK. The results of this pilot study suggest that only 40% of respondents regularly tell patients the diagnosis. Although physicians are aware of many benefits in disclosing, they have concerns regarding the certainty of diagnosis, the patient's insight, and potential detrimental effects. The advantages of disclosure and the ethical issues involved are discussed.
    • Truth-telling and the diagnosis of dementia

      Pinner, Gill (2000)
      Discusses the disclosure of the diagnosis of dementia, suggesting that most research on truth-telling in relation to diagnosis is held in the cancer literature. Little is known about the attitudes held and current practice by psychiatrists and physicians toward disclosing a dementia diagnosis. Topics covered include the advantages and disadvantages of disclosure and ethical issues involved. Research on geriatricians and psychiatrists of old age suggests that most do not tell their patients the diagnosis, but that most would wish to know themselves. Research on caregiving relatives of Alzheimer's disease (AD) patients suggests that most would not want their relative to be told of the diagnosis. Less is known about patient preferences. The moral doctrine of diagnosis disclosure is derived from a respect for the patient's autonomy as well as beneficence. The article also gives suggestions on when and how to deliver the diagnosis of dementia. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Evaluating care delivery: The application of dementia care mapping in learning disability residential services

      Persaud, Michelle; Jaycock, Sue (2001)
      Explored how good practice in relation to quality of care initiatives in dementia care transpose into learning disability settings. Dementia care mapping (DCM), an evaluation method that measures quality of care from the service user's perspective, was applied in learning disability environments to evaluate its effectiveness and efficiency in this setting. 22 Ss (aged 20-63 yrs) with severe mental impairment (excluding dementia) and communication difficulties were observed to test the assertion that DCM could help to evaluate their experiences of receiving care which they could not describe for themselves. Three residential care areas were observed. Observations recorded a behavior category code, a well-being/ill-being score, personal detractions, and positive events. Results demonstrate the application of the method to be partially successful. The data produced compare favorably in quality, quantity, and detail with those collected in dementia care areas. The authors conclude that an analysis of data reveals great potential for DCM; however, they add that modification and adaptation of result indices and coding frameworks should be considered as possibilities for future work. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • How DCM may affect caregiver mappers

      Neel, Andrew (2002)
      Dementia Care Mapping had a huge effect on Andrew Neel's perception of his role as a caregiver. In this second of a series of articles on DCM he explores his experiences and how we might reflect on this tool's impact on staff.
    • To tell or not to tell: On disclosing the diagnosis of dementia

      Pinner, Gill; Bouman, Walter P. (2002)
      Research suggests there has been a cultural change in the disclosure of diagnosis with most evidence held in cancer literature. This article reviews how disclosure of diagnosis relates to the field of dementia. Practitioners' attitudes and practice are being discussed, as are the attitudes and views of carers, peer groups, and patients. Practitioners show great variations in practice, with only around 50% of clinicians regularly telling patients with dementia their diagnosis. The majority of carers also appear to prefer the diagnosis to be withheld from the patient with dementia. Most practitioners and carers would wish to know themselves if they had the illness. Studies on the views of elderly peer groups show that the vast majority wishes to be fully informed, views of patients with dementia regarding the area of disclosure are still lacking. Factors influencing the decision to disclose the diagnosis, including the degree of certainty of the diagnosis of dementia, the degree of insight of the patient, and the severity of the dementia, are investigated. The advantages and disadvantages of disclosure and the ethical issues are examined, as well as when or whether and how to disclose the diagnosis of dementia. Flexible guidelines regarding the process of disclosure are introduced. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • What should we tell people about dementia?

      Pinner, Gill; Bouman, Walter P. (2003)
      This article reviews what we should tell patients and carers about dementia. The attitudes and views of patients, carers and peer groups are examined, as is the practice of doctors and other professionals working in dementia care. Factors influencing the decision to disclose the diagnosis of dementia, including the degree of certainty of the diagnosis, the degree of insight of the patient and the severity of the dementia are considered. Advantages, disadvantages and ethical issues of disclosure are discussed, as well as when or whether and how to disclose the diagnosis. Flexible guidelines regarding the process of disclosure are introduced.
    • Using pre-therapy techniques in dementia care

      Morton, Ian (2004)
      Pre-therapy techniques in interpersonal interaction with patients. This technique is used with people with dementia, where the patient leads the direction of the conversations and which is consistent with person-centred philosophy.
    • Down's syndrome and dementia

      Stanton, Lisa R.; Coetzee, Rikus H. (2004)
      Down's syndrome is the most common genetic disorder seen in clinical practice: about 94% occurs because of non-disjunction of chromosome 21 and 3-5% because of translocation. Individuals increasingly survive to middle and old age, probably because of advances in medical treatment and improved living conditions. People with Down's syndrome have an increased risk of developing Alzheimer's disease in middle age. Within ICD-10 and DSM-IV classifications there is no consensus on the diagnosis of dementia in people with learning disability. New treatments have been licensed for use in mild to moderate Alzheimer's disease (e.g. acetylcholinesterase inhibitors and memantine). The comorbid picture of Down's syndrome and Alzheimer's disease presents a unique challenge to the clinician in both diagnosis and management.
    • The meaning of incontinence in dementia care

      Upton, Norman (2005)
      Exploring ways of helping dementia sufferers and their carer's cope at home is central to government philosophy and legislation (Department of Health, 2001). The success of such support relies on having an accurate understanding of the nature and extent of the illness, and the caregiving experience. This article recognises and validates the pre-eminent role of spouse caregivers in the day-to-day maintenance of dementia sufferers. In so doing, it promotes a caregiver-coping paradigm as the most sensible and effective approach to formulating clinical assessment and service delivery. There is a dearth of research exploring the influence of incontinence on caregiver coping. This is surprising bearing in mind the seemingly obvious difficulties it creates for the caregiver. This relationship, described and discussed from a caregiver perspective, provides a valuable example of the need for a paradigm shift in the way professionals and services support and care for people with dementia and their spouses.;
    • 'Is the cooker turned off?' Caring for an older person with falling memory

      Bouman, Walter P. (2005)
      Reviews the book, ''Is The Cooker Turned Off?' Caring For An Older Person With Failing Memory," by Josephine and Michael Woolf. The book covers every aspect of caring for someone with dementia, from understanding memory to helping a person with dementia to remember things, using cues, association, diaries, note-books, visitors' books and routine checklists; from personal safety to personal care to the carer's own well-being, both physically and psychologically, whilst retaining a compassionate eye to the dignity of the cared-for person. This book is recommended to a number of different readers. Firstly to patients in the early stages of their illness, who retain a degree of insight and are interested and brave enough to want to learn about a multitude of aspects of their likely future journey. Secondly, to all carers, both informal and professional, for whom this book offers invaluable insights into the various roles of being a carer. Thirdly, to all other aspiring and practicing colleagues in the field of dementia, if only to recommend it to patients and carers alike. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    • Caregiver coping in dementing illness--implications for short-term respite care

      Upton, Norman (2005)
      The increasing cost of caring for older people with dementia is just one of two key justifications for researching service interventions designed to help sustain dementia sufferers within their own home. Secondly, studies consistently highlight an almost universal determination by spouse caregivers to avoid institutionalisation by coping to the 'bitter end' or at least until their coping resources have been irrevocably depleted (Knight et al, 1993; Barnes et al, 1981; Upton, 2001). The experience of coping with a dementing spouse is known to be enduring, stressful and pathogenic to the caregiver (Schwarz and Blixen, 1997; Rosenheimer and Francis, 1992). Many carers describe short periods of personal private time and space away from the psycho-physiological demands of caregiving as therapeutic coping facilitators. The term 'respite care' (essentially a professional colloquialism) is a multi-agency response to the needs of such carers and typically refers to a range of interventions from befriending/sitting services; day-care services; to short-term residential/in-patient care. This paper, taken from a PhD study into the day-to-day coping experience of forty-six spouse carers (Upton, 2001), explores the issue of coping and its respite implications for day and short-term residential/in-patient care. The high status of the respite concept as coping enhancer is highlighted along with the dangers of using an intervention, which can paradoxically accelerate expensive, unwanted and primarily unnecessary long-term care placement.;
    • The influence of social support on caregiver coping

      Upton, Norman (2006)
      Investigations into the act of proving care to a dementing family member typically approach the phenomenon from a stress/burden paradigm. Many studies have sought to highlight the relationship between of a range of dementia care factors (such as illness duration, patient symptoms/characteristics, service provision, etc.) and the experience of caregiver stress. Caregiving a spouse with dementing illness is complex and multidimensional (Gubrium, 1995) it is therefore not surprising that the vast majority of stressor-based approaches, though very revealing, have been largely equivocal in their findings. The relationship between the social support of family and friends and caregiver coping is no exception and therefore remains essentially unclear particularly in terms of its contribution in ameliorating stress (Thompson et al, 1993). Caregiver studies do however consistently highlight the pathogenic qualities of coping with an experience in which 'families are faced with often overwhelming and uncontrollable stress than can take a toll on their emotional health and well-being' (Zarit et al, 1998; Bourgeois et al, 1996). This article, emanating from a PhD study into caregiver coping (Upton, 2001), illuminates the study of caregiving from a different perspective. It highlights and describes how phenomenological exploration deepens our understanding of how and why spouse caregivers cope and uses the influence of social support as an exemplar of the value and need for such exploration both for its own sake and also to inform service providers. The results revealed a universal phenomenon of psycho-physical distancing by family and friends affecting all forty-six spouse caregivers included in this study. The implications of these finding are discussed along with what constituted social support for these carers. Other phenomenological insights are revealed, not least how the individual caregiver's relationship to time, space and their own identity shaped their caregiving experiences.;
    • On mental health

      Taylor, Jeremy (2006)
    • What does phenomenology offer to the study of care-giving?

      Upton, Norman (2006)
      Care giving to a dementia sufferer is complex (Parsons, 1997) and inherently stressful (Baldwin et al 1989). It is suggested that the predominance of the care-giver stressor-burden research paradigm during the last thirty years has frequently been uni-dimensional, objectively oriented, generally equivocal, and unconvincing in its findings. Dillehay and Sandys (1990), suggest that preoccupation w ith such typically narrow approaches has delayed the much-needed development of a more accurate understanding of the lived experience (the phenomenology of care-giving). Researching the experience of care giving to a dementing relative requires a research strategy, which acknowledges the intricacies, complexities, subjectivity and humanness of that experience. That is the premise behind this paper. A multi-dimensional phenomenological PhD study is presented. The focus is on understanding care giving from the individual and collective perspectives of forty-six spouse caregivers. The methodological implications (including influences of Husserl and Heidegger) are outlined before the phenomenological research findings are presented and discussed. Ethical approval was given by the Bassetlaw Hospital and Community NHS Trust Ethics Committee (now part of the Nottinghamshire Healthcare NHS Trust).;
    • The effectiveness of dementia care mapping in intellectual disability residential services: A follow-up study

      Jaycock, Sue; Persaud, Michelle (2006)
      This article is presented as a follow-up to exploratory work published in this journal in 2001. It describes a study that aimed to assess the effectiveness of dementia care mapping in supporting practice improvement in intellectual disability residential services. An average of 9 hours of observational data was collected using dementia care mapping in relation to 14 adults with severe or profound intellectual disabilities. Sixteen interviews were also undertaken with staff over a 4 month period.The findings provided a detailed picture of the activities and interactions between the participants involved in the study and raised some issues about 'organizational culture' when developing person-centred approaches. They have helped strengthen the case that care mapping has the potential to be a useful addition to the existing repertoire of tools to support effective practice improvement and person-centred planning.;