Meaningful occupation is a frequently stated part of person-centred care, but that need is often unmet in long-term care (LTC) settings. There is little in literature about the perspective of people with moderate and severe dementia on their identity construction and social roles. This study deals with the following question: how do men and women with moderate to severe dementia living in long-term care maintain aspects of their identities and social roles? It also gives insight into the application of a narrative-in-action approach with people with advanced dementia. Using a qualitative research design in the ethnographic tradition, observations, interviews and informal talks whilst doing occupations with people with dementia and their carers were used for data collection in two institutions. A narrative analysis based on a narrativein-action approach was applied. The findings show the efforts of people with dementia doing "identity work" in a confining environment. They used narratives, objects, and occupations to express their identities despite their cognitive or physical impairments. The narrative-in-action approach offers the potential to better understand the perspective of people with dementia who have problems expressing themselves verbally. Even though they are fragmented, repeated stories have an important function in constructing identity and should not be regarded merely as a symptom of dementia. This study allows for a better understanding of the relationship between occupation, its symbolic meaning, and identity in people with advanced dementia.
ARTICLE HISTORYLittle is known about the relationship of identity and meaningful occupation in people with advanced dementia. This paper has two aims: first, to present the application of a narrativein-action approach (Alsaker, Josephsson, & Dickie, 2013) in people with advanced dementia and second, to present findings about the relationship between identity and occupation in this group. After a short literature review, the design and methods of the study are described, followed by a more in-depth discussion of the theoretical background of narrative theory. In the findings section, two case stories of older women with advanced dementia are presented and discussed. Finally, implications for occupational science and dementia care are stated.
Dementia and Everyday OccupationsDementia is a syndrome involving changes in the brain that lead to disability and problems