| 1. |
- Rahm Hallberg, Ingalill, 1944-
(författare)
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Vocally disruptive behaviour in severely demented patients in relation to institutional care provided
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Thirty-seven patients identified as vocally disruptive and a control group, selected from 264 patients at psychogeriatric wards were studied. Tape-recordings of their vocal behaviour, ratings of their functional performance and symptoms related to dementia, observations of their behaviour, activities and interaction with caregivers were performed. Seventeen plus sixteen caregivers were interviewed to give their interpretation of the experience behind the behaviour and describe their own experience of it. The severely demented vocally disruptive patients were found to be significantly more physically dependant, disorientated at the ward and prone to confusional reactions but they had a more preserved speech performance than the controls. The vocal activity expressed such as helplessness, pain, fear and protest. Some were emotionally indifferent and a few expressed positive emotions. Caregivers interpreted the behaviour as an expression of anxiety related to such as abandonment, dissolution and loss of autonomy. They also expressed a strong wish to comfort the patients but felt unable to do so. The patients' daily life was characterized by idleness and solitude. Caring activities and interactions were dominated by physical procedures performed in a fragmentary and rapid way. Two hypotheses are generated. 1. Vocally disruptive behaviour develops influenced by sensory deprivation and the brain damage. 2. The care provided is influenced by caregivers experiencing anxiety in the patients as well as experiencing a conflict between the care they would like to provide and the care they actually provide. This evokes anxiety in them which elicits defence mechanisms leading to emotional withdrawal from the patients and task oriented care. The results are discussed in a nursing perspective based on existential thoughts, psychoanalytic and psychosocial theory.
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| 2. |
- Åkerlund, Britt Mari, 1943-
(författare)
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Dementia care in an ethical perspective : an exploratory study of caregivers' experiences of ethical conflicts when feeding severely demented patients
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to explore how caregivers caring for severely demented patients experience ethical conflict situations. Feeding patients in a late state of dementia was chosen as focus. Special attention was paid to analyses of the caregivers' experiences with regard to their feelings, use of force, interpretations of the patients' behaviour and their ethical reasoning.The study was carried out in five separate parts, presented as five papers. A phenomenological - hermeneutic approach was consistent. Personal interviews, a projective defence mechanism test, the Meta Contrast Technique and an analysis of patient/caregiver behaviour as shown in video taped feeding sessions were the methods used.Study participants were forty-one caregivers in psychogeriatric care, registered nurses, licensed practical nurses and nurses' assistants.The result indicated that, when facing ethical decisions the caregivers were caught in a double bind conflict due to the contradicting ethical demands "Keep the patient alive!" and "Don't cause the patient suffering!". The difficulty to interpret what the patients experienced and the impossibility to know for sure what actions would be right or wrong were sources of anxiety. They defined force feeding individually, yet a pattern was found. Some caregivers defined force feeding according to the amount of persuasiveness or violence they had to perform. Some regarded force feeding from a patient wish perspective. A majority combined the two dimensions.The caregivers' ethical reasoning showed that their decision making was to be regarded as a process grounded on ethical rules. Interdependence in the relation caregiver/patient made them develop their reasoning in a direction of existential reasoning.
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| 3. |
- Åström, Sture, 1946-
(författare)
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Attitudes, empathy and burnout among staff in geriatric and psychogeriatric care
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study concerned assessments of attitudes towards demented patients among students and nursing staff as well as attitudes towards active euthanasia, wish to transfer to other jobs, ability of empathy and experience of burnout among nursing staff. The study aimed also to relate experience of burnout to attitudes towards demented patients, ability of empathy and experience of work with demented patients. The study was performed by use of questionnaires, scales measuring attitudes towards demented patients, experience of burnout and ability of empathy. Tape-recorded interviews were also included aiming to explore the staffs experience at work.The results showed that a majority of the students and staff held positive attitudes towards demented patients. A small proportion intended to work solely with demented patients. Staff working in psychogeriatric care and somatic long-term care held more positive attitudes than staff working in acute medical care. Proportions of staff with positive attitudes varied depending on age, duration of employment, education and place of work. A larger proportion of staff in geriatric care than in acute care reported a wish to transfer to another job. LPN’s in nursing homes to the largest proportion stated this wish to transfer.A majority of both students and staff expressed negative attitudes towards active euthanasia to severely demented patients in the finale stage of life. However, most favourable attitudes towards active euthanasia were found among students with shorter health care education and among nurse's aides and LPN’s.The staffs empathy was judged as moderately high and there were no differences found in relation to sex, staff category or place of work.Experience of burnout /tedium varied with the place of work and category of staff. Largest proportions at risk to develop burnout were found among those working in somatic long-term care and psychogeriatric care. RN’s showed lower burnout scores than nurse's aides and LPN’s.Experience of burnout was correlated to attitudes towards demented patients, indicating that the lower burnout score the staff have the more positive are the attitudes. Burnout was also related to the staffs ability of empathy i.e. the lower degree of burnout the higher is the empathie ability. Regression analysis showed that "Experience of feed-back at work” and "Time spent at present place of work" were the most important factors for the staffs experience of burnout.
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| 4. |
- Sällström, Christina, 1950-
(författare)
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Spouses' experiences of living with a partner with Alzheimer's disease
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the study was to gain some understanding of the lived experience of the care-giving spouses regarding their experiences of the manifestations of the disease, perception of their own health, the possibility of influencing the interpretation of the past, the present and future, outlook on life, surrounding contacts and intimate relationships with their sick partners. The spouses (n=13) of Alzheimer victims were followed with the help of personal interviews, diaries and telephone interviews during a two-years period. The texts was analysed according to a phenomenological-hermeneutic method. The main findings in the study showed that the spouses own health remained quite stable over time. Their perception of the development of their own health seemed to be influenced by how they saw their power to influence their situation, which seemed to be determined by how they interpreted the cause of their health problems.The social network was another important factor for understanding the spouses' experiences. The findings imply that spouses' images of themselves in relation to others were important for their perception of the overall social network. The spouses mostly regarded their relationships positively and their social networks were described as quite stable over time. The spouse's marital relationships, in most cases, seemed to undergo changes with the progress of the disease. Some spouses could maintain feelings of love but mostly the relationships were transformed into ones of tenderness, pity and estrangement. The spouses' valuation of their demented partner was mostly in the form of one of two divergent perspectives. On the one hand, spouses who seemed to perceive their partner as a person separate from the disease, could function as complementary ego aids. On the other hand some spouses were unable to make a distinction between the spouse as a person and the disease.The spouses' experiences regarding their previous relationship with parents, value system, philosophy of life, competence and autonomy seemed to be critical in their experiences of their caring situation. It appears that there is a sub-group of vulnerable carers, as suggested by the concurrence of psychological, physical, and social morbidity, along with deterioration in their marital relationship.The findings are discussed in relation to searching for meaning, the importance of significant others, perceiving and valuing the other, and caring relationships within a life-span perspective.
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| 5. |
- Gustafson, Yngve, 1949-
(författare)
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Acute confusional state (delirium) : clinical studies in hip-fracture and stroke patients
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Acute confusional state (ACS) or delirium according to DSM-III-R holds a central position in the medicine of old age. ACS is a common and sometimes the only symptom of diseases and medical complications in the elderly patient.The aim of this study was to elucidate ACS in patients with femoral neck fractures and patients with acute stroke with regard to frequency, predictors, possible pathogenetic mechanisms, associated complications, assessment and documentary routines and the clinical outcome for the patients. An intervention program to prevent postoperative ACS based on our results was developed and evaluated.The main findings of the study were high frequencies of ACS in elderly patients with femoral neck fractures (61 %) and in patients with acute stroke (48 %). The main risk factors for ACS in patients with femoral neck fractures were old age, diseases and drug treatment interfering with cerebral cholinergic metabolism. There was no link between anaesthetic technique and ACS but the connection between peroperative hypotension, early postoperative hypoxia and ACS was close.In stroke patients the degree of extremity paresis and old age were independent ACS risk factors. ACS was commonly associated with post stroke complications such as myocardial infarction, pneumonia, urinary infection and urinary retention. In stroke patients there was a close connection between high hypothalamic-pituitary-adrenal axis (HPA-axis) activity and ACS. High HPA-axis activity and disturbances in the cerebral cholinergic system may be two important ACS mechanisms.A correct diagnosis is a prerequisite for proper treatment of ACS and its underlying causes. In the orthopaedic wards both physicians and nurses diagnosed and documented ACS poorly and therefore associated complications were insufficiently treated.The intervention program for postoperative ACS, aimed mainly at protecting the cerebral oxidative metabolism and thereby the cerebral cholinergic metabolism which is especially sensitive to hypoxia. Postoperative complications associated with ACS were also treated. The intervention resulted in reduced frequency, duration and severity of postoperative ACS and in shorter orthopedic ward stay for patients with femoral neck fractures.Key words: Acute confusional state, delirium, elderly
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| 6. |
- Herlitz, Agneta, 1962-
(författare)
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Remembering in Alzheimer's disease : utilization of cognitive support
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the present doctoral thesis was to investigate the ability of patients with Alzheimer's disease (AD) to utilize cognitive support in order to improve episodic remembering. A review of previous research indicated that most studies have failed to find beneficial effects of encoding support on memory in AD patients. The ability to utilize cognitive support (i.e., motoric activities, semantic organization, and semantic knowledge) for episodic remembering was investigated in five studies (Bäckman & Herlitz, 1990; Herlitz, Adolfsson, Bäckman, & Nilsson, in press; Herlitz & Bäckman, 1990; Herlitz & Viitanen, in press; Karlsson et al., 1989). Patients with mild, moderate, or severe AD, and normal older adults participated in the studies. On the basis of the results from these studies and the review of the literature, it was concluded that (a) AD patients, irrespective of dementia severity, perform at a lower level than normal older adults in episodic memory tasks; (b) provided that support is supplied at retrieval, AD patients may be sensitive to manipulations at encoding; (c) the strength of the encoding manipulation determines the size of the memory improvement in AD patients; and (d) depending on dementia severity, the type of encoding support also determines the magnitude of memory improvement obtained.
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| 7. |
- Österlind, Per Olov, 1947-
(författare)
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Medical and social conditions in the elderly gender and age differences : the Umeå longitudinal study
- 1993
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In 1981, no representative study of the medical and social conditions among elderly persons in northern Scandinavia was performed. Nor was there such a study in a smaller Swedish town than Gothenburg. This study was initiated to fill that knowledge gap. The aim of the study was to evaluate gender and age differences in medical and social conditions among elderly people, including the reference intervals of clinical chemistry parameters and characteristic features of the 24-hour electrocardiogram (ECG) in healthy elderly. By way of longitudinal design with birth cohorts stratified by gender, it was assumed that the effects could be demonstrated. Also, the death risk of various social and medical variables was to be assessed.During the study period 1981 to 1990, the subjects were between 70 and 88 years of age. The proportion of persons living in private housing decreased from almost all at the age of 70 to slightly more than half at 88 years of age. The number of socially active persons decreased considerably during the period. The need of help increased from almost none to 60 % of the persons.The proportions of persons with normal sight and hearing decreased from two thirds to around one tenth The most frequent symptoms were general tiredness, pains, dyspnoea, constipation and dryness of the mouth. Cardiovascular diseases were the most frequent. Hypertensive disease became less, and congestive heart failure more frequent with age. The frequency of dementia increased steeply among the oldest persons; at 88 years of age, 40 % were demented.Drug consumption increased; the oldest persons in both age cohorts used 5 different drugs or more per person regularly. The consumption increase was mainly due to the increasing morbidity accompanying age. The most common drugs taken were cardiovascular preparations, psychoactive agents, drugs to alleviate gastrointestinal symptoms, and analgesics. Drug intake and symptom prevalence were generally higher in women, despite the fact that there was no gender difference in the number of diseases.The reference intervals of many blood components in healthy elderly were shown to be broader than those of younger persons. The intervals of P(lasma)-folate and P- potassium were on a lower and those of the erythrocyte sedimentation rate, P-creati- nine and, in women, S(erum)-cholesterol, were on a higher level than among younger persons.Several features of the 24-hour ECG, e.g. the number of episodes of supraventricular tachycardia as well as supraventricular and ventricular premature beats in healthy elderly were more frequent than among younger persons.Between 80 and 88 years of age, many functions crucial to the chances of living a rich and vital life were found deteriorating in the elderly persons. High age, male sex, dementia, congestive heart failure, and low values of S-creatinine were shown to be independent factors connected with an increased death risk.
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