Objectives: The arts are increasingly recognised as important and beneficial activities for people living with dementia. However, there is little peer-reviewed published research exploring arts-based learning for dementia care staff. In response, this paper explores (a) how dementia care staff describe forms of communication in care settings, and (b) the impact on communication following four sessions of ‘Creative Conversations’, an arts-based intervention for skills development. Method: Fourteen care homes received the intervention, delivered as 4 × 2 hour sessions. The intervention uses a range of activities (e.g. poetry, film, music, art making). Twenty–eight care staff were opportunistically sampled (mean age = 42.29), and provided pre-post qualitative data, obtained through interviews. Transcripts were analysed thematically. Results: At baseline, the dominant ‘task-focussed’ nature of care work was described as a barrier to communication, challenging opportunities for developing meaningful relationships with residents. Post-intervention, three primary themes were identified regarding improving communication: (1) learning through the arts (secondary themes: simplicity and subtlety, innovation in communication , and strengthening the role of non-verbal communication ), (2) Enhancing creative approaches to care (secondary themes: element of surprise, confidence to experiment and catalyst for communication ) and (3) professional introspection (secondary themes: development of empathy, sharing knowledge and experiences and a new appreciation ). Conclusions: The intervention validated staff skills and confidence, enabling meaningful interactions that could be creative, ‘in the moment’, spontaneous and improvised. This arts-based intervention, which departs from formal education and fact-based learning may be particularly useful for the development of the dementia care workforce.
Objectives: This study aimed to explore the quality of life and well-being of care home residents living with advanced dementia, how personalised care can be achieved where the person is completely dependent on others for care and how individuals’ choices and human rights were upheld. Methods: The study design used a qualitative approach, with data collected through in-depth, semi-structured interviews with 8 family members, all of whom visited daily, and 8 care staff. Results: Emerging themes highlighted the importance of family involvement, signs of well-being, communication and the valued role of direct care staff. Discussion: Participants were able to identify factors of residents’ well-being in residents living with advanced dementia. Family members who visited daily saw themselves working collaboratively with care staff to maintain the quality of life of their relatives and engage in proxy decision making. Regarding human rights, the emphasis was on avoiding abuse, rather than promoting well-being.
Psychometrically sound resilience outcome measures are essential to establish how health and care services or interventions can enhance the resilience of people living with dementia (PLWD) and their carers. This paper systematically reviews the literature to identify studies that administered a resilience measurement scale with PLWD and/or their carers and examines the psychometric properties of these measures. Electronic abstract databases and the internet were searched, and an international network contacted to identify peer-reviewed journal articles. Two authors independently extracted data. They critically reviewed the measurement properties from the available psychometric data in the studies, using a standardised checklist adapted for purpose. Fifty-one studies were included in the final review, which applied nine different resilience measures, eight developed in other populations and one developed for dementia carers in Thailand. None of the measures were developed for use with people living with dementia. The majority of studies (N = 47) focussed on dementia carers, three studies focussed on people living with dementia and one study measured both carers and the person with dementia. All the studies had missing information regarding the psychometric properties of the measures as applied in these two populations. Nineteen studies presented internal consistency data, suggesting seven of the nine measures demonstrate acceptable reliability in these new populations. There was some evidence of construct validity, and twenty-eight studies hypothesised effects a priori (associations with other outcome measure/demographic data/differences in scores between relevant groups) which were partially supported. The other studies were either exploratory or did not specify hypotheses. This limited evidence does not necessarily mean the resilience measure is not suitable, and we encourage future users of resilience measures in these populations to report information to advance knowledge and inform further reviews. All the measures require further psychometric evaluation in both these populations. The conceptual adequacy of the measures as applied in these new populations was questionable. Further research to understand the experience of resilience for people living with dementia and carers could establish the extent current measures -which tend to measure personal strengths -are relevant and comprehensive, or whether further work is required to establish a new resilience outcome measure.
The number of individuals living with advanced dementia in the care home sector is growing as people live longer. People living with advanced dementia have complex, individual needs and identifying contributors of their well-being is essential in maintaining and promoting their quality of life. Currently, little is known on quality of life and well-being in advanced dementia. A mixed method approach was used to understand the lived daily experience of residents with advanced dementia. The article presents a case study of two residents, " Graham and Martha". Methods include AwareCare observations, QUALID ratings and qualitative interviews with relatives and key staff members, gathered over a period of eight months. Although they both had limited verbal ability, they demonstrated the urge to communicate and non-vocal behaviours were used convey their feelings. The findings suggest that relatives are reassured/comforted where they see their relatives expressing themselves, and happier when they could maintain a regular caring role. Relatives also were appreciative of staff caring for the individual as a person. However, conflict was evident when care staff and relatives did not agree on what would be in the best interests of the person living with advanced dementia. Kitwood's personhood model was especially helpful in considering well-being in advanced dementia.
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