Occupation, Self and Dementia – what can we learn from the perspective of women and men with moderate to severe dementia living in long-term care?

Background: People with dementia living in Long-term-care (LTC) settings can be at risk of occupational deprivation due to cognitive issues or institutional factors. Activities and occupations have the potential to promote... [ view full abstract ]

Background:
People with dementia living in Long-term-care (LTC) settings can be at risk of occupational deprivation due to cognitive issues or institutional factors. Activities and occupations have the potential to promote autonomy and are supposedly linked to identity and self (Christiansen, 1999).There is a growing interest in concepts like personhood (Kitwood & Bredin, 1992) and self (Caddell & Clare, 2013) in people with dementia, as they seem to be related to wellbeing (e.g.Cohen-Mansfield et al., 2012). There is little evidence stemming from people with dementia themselves (e.g.Harmer & Orrell, 2008; Raber et al., 2010) in the later stages.
Methods:
Using a qualitative approach inspired by ethnography (Nygard, 2006; Hammersley & Atkinson, 2007), the experiences of activities and participation of four women and men with moderate to severe dementia were explored through observations and interviews over a period of several months up to a year in two different LTC settings. Observations included next of kin and staff in a variety of situations.
Results: Preliminary findings show that people with dementia strive for continuity through different strategies using activities, objects, narratives; physical and social environment. Using a transactional perspective (Cutchin & Dickie, 2014) could lead to a better understanding of self and occupation in people with dementia.
Conclusion: People with dementia with different abilities and environmental conditions make attempts to construct an acceptable identity despite advanced age, cognitive issues and organizational restraints.
Application to Practice:
These findings can be a starting point for interventions for people in the later stages of dementia.