Existential Issues in the Management of the Demented Elderly Patient

Abstract

Four major existential themes are explored, as they relate to the predicament of the relative supporting a demented elderly dependent at home. These issues, namely, death, isolation, freedom, and meaning are discussed with respect to their dynamic impact on the stressed supporter as well as their implications for anxiety management.

The impact of relationships, motivations, and meanings on dementia caregiving outcomes

“…The unexpected finding of the link between extrinsic motivations and meaning indicates that perhaps it is the caregivers' awareness of their reasons for providing care that helps them find meaning in their role. Levine et al (1984) argued that caregivers need to find meaning in the choices they have made, for instance, commencing and continuing caregiving. The findings from correlational analyses indicate that intrinsic and extrinsic motivations, meaning, and pre-caregiving and current relationship quality were individually related to the measures of caregiving outcomes.…”

Nurses' experiences of strain and their reactions in the care of severely demented patients

“…The authors used their own experience from research in the field and findings from family care that were regarded as relevant for nursing care as further bases for the scales. Important dimensions thus reported were the nurses' experience of meaning and meaninglessness in the patient and in the care (Asplund, 1991;Levine et al, 1984;Norberg and Asplund, 1990;Akerlund and Norberg, 1990), feedback, a non-functioning relationship (Athlin and Norberg, 1987a,b;Bjorkhem et al, 1992;Hirschfeld, 1981;Hughie, 1967;Levine et al, 1984;Stephens er al., 1991), the degree of anxiety in the patient (Hallberg and Norberg, 1990;Harper and Lund, 1990), agitated and/or aggressive behaviour (Harper and Lund, 1990;Hughie, 1967;Smith et al, 1991), patients' lack of autonomy (Ekman and Norberg, 1988) and patients' resources for finding out and communicating their needs (Bjorkhem et ul., 1992;Ekman etal., 1991). Nurses have reported, for instance, anxiety (Given et al, 1988;Hallberg and Norberg, 1990;Levine et al, 1984), feelings of meaningfulness and meaninglessness (Asplund, 1991;LeJine et al, 1984), powerlessness (Hallberg and Norberg, 1990;Hughie, 1967;Levine et al, 1984;Akerlund and Norberg, 1990), ethical difficulties (Jansson and Norberg, 1992;Levine et al, 1984) and negative reactions to patients' physical appearance (Asplund and Norberg, 1993).…”

Existential Concerns of Families of Late-Stage Dementia Patients: Questions of Freedom, Choices, Isolation, Death, and Meaning

“…In a fundamental theoretical article by Levine et al, 27 existential issues in their stricter meaning are taken up. In that article issues of death, freedom, isolation and meaning are examined in terms of patients with dementia and their next-ofkin.…”