Emotional safety of people living with dementia: a systematic review

Abstract

Background: Emotional safety is particularly important for people living with dementia. Although there have been efforts to define this concept, no systematic review has been performed. Aim: We aimed to identify and analyze the knowledge available over a 10-year period regarding the emotional safety of people living with dementia to concretize this phenomenon. Methods: Seven databases were searched. Qualitative, quantitative and mixed-methods studies published between November 2007 and October 2017 were included. Study selection and critical appraisal were performed by two reviewers. A content analysis of the qualitative data and a descriptive analysis of the quantitative data were performed. Results: In total, 27 publications (n ¼ 26 studies) were included. The following five main categories were identified: (1) "emotional safety as a primary psychological need"; (2) "emotional safety in the context of disease-related, biographical, demographic and socioeconomic factors"; (3) "inner conditions and strategies"; (4) "outer conditions and strategies"; and (5) "emotional safety as a condition". Conclusion: People living with dementia appear to be particularly vulnerable to decreased emotional safety. Research should focus on achieving a comprehensive understanding of their emotional safety needs.

Emotional Safety in the Context of Dementia: A Multiperspective Qualitative Study

“…In general, emotional safety can be influenced by dementia-related, psychosocial, biographical, physical, and economic factors. Psychosocial factors (e.g., inter-role conflicts) are an additional subdimension of influencing factors described in our previous systematic review [1]. This finding underpins our findings of a complex view of the phenomenon.…”

“…Failure to consider emotional safety could lead to emotional distress, which PlwD can experience as feelings of fear or loneliness [ 5 ]. Consistent with the current literature [ 2, 6– 10 ], emotional safety in the context of dementia is defined as “the experience of people [in the context of dementia] (...) on a continuum between feeling safe and feeling threatened in the context of subjectively perceived inner and outer conditions” [ 1 ]. Emotional safety “refers to the psychological impact of receiving/providing services” [ 2 ].…”

“…Feeling safe is a primary psychological need of people living with dementia (PlwD) because of their increased general vulnerability and reduced emotio-nal safety [ 1 ]. Living with a chronic disease often has a strong impact on coping with changes, and several community or home related entities are involved [ 2 ].…”

“…Emotional safety “refers to the psychological impact of receiving/providing services” [ 2 ]. Emotional safety in the context of dementia can be influenced by several factors [ 1 ], e.g., psycholo-gical, disease-related, biographical, demographic, socioeconomic, and environmental (social and phy-sical). Therefore, a more comprehensive view of emotional safety is needed as a part of a multiperspective approach involving PlwD, relatives of PlwD, and public stakeholders.…”

“…The authors identify a broad range of safety risks and describe themes related to preventing emotional harm, including ”respect and dignity”, “preventing loneliness”, “avoiding negative feelings”, and “promoting good moments and positive feelings” [ 11 ]. Although the current research acknowledges the relevance of emotional safety, particularly in relation to dementia, our recent review revealed that limited evidence is available regarding emotional safety in the context of dementia [ 1 ]. Additionally, a comprehensive view that equally considers the perspectives of PlwD, relatives of PlwD, and public stakeholders that compares the different experiences of relevant groups in local contexts is lacking.…”