Social aspects of dementia and dementia practice.

Social aspects of dementia are becoming increasingly important as part of a wider shift in emphasis from cure to care. This is partly because approaches based on finding a cure have proved far more difficult and complex than originally imagined (WHO, 2016). New evidence on the effectiveness of public health measures, that while incidence is growing as the proportion of older people in society increases its prevalence amongst older adults is actually falling, has also lead to increased interest in social dimensions of prevention, lifestyle change, and practical intervention in community settings (Prince et al., 2016; Kivipelto et al., 2017). This, in turn, has led to a rediscovery of the role of supports to people living with dementia in their daily lives, the needs of informal carers, and professional activities that can maintain the social engagement of each party (Winblad et al., 2016). The expansion of practice around person-centered care, beyond traditional institutional settings, has also contributed to a socialized view of how interactions in dementia care are thought about (Bartlett et al., 2017), as has an increased awareness of the effects of the social construction of dementia in the public mind (Biggs, 2018). Most recently, people living with dementia, and particularly with respect to younger onset dementia, have begun to find a voice and to make connections to the wider disability movement (Dementia Alliance International, 2017). Each of these developments, in their different ways, have led to a re-emphasis on psycho-social elements of dementia, its experience, and how that might translate into clinical practice and service delivery.

Differences in priority by age group and perspective: implications for public health education and campaigning in relation to dementia.

ABSTRACTObjectives:A shift toward public health responses to dementia, raises questions about the most appropriate approaches to specific population groups. We examined perspective and age as elements in effective campaigning. Implications from the standpoint of the recipient are drawn for public health education and practice. DESIGN: In-depth semi-structured face-to-face and telephone interview with self-selected participants recruited via adverts, contact with provider organizations and cards placed in retail and service settings. Questions focused on attitudes to dementia and expectations of public campaigning and education. SETTING: Community-dwelling adults were interviewed across five Australian states. PARTICIPANTS: A total of 111 people from 5 target groups: people with dementia (n = 19), carers (n = 28), care work and service professionals from healthcare (n = 21), social work (n = 23) and commercial service professions (n = 20) involving people in younger adulthood (n = 13), early midlife (n = 23), later midlife (n = 54), and older age (n = 21). MEASUREMENTS: All interviews were transcribed and analyzed thematically by three researchers, reaching consensus before coding and further analysis in NVivo. Narrative analysis of transcripts included 330 topics relating to 6 main areas of focus. RESULTS: Attitudes and views on effective future campaigning reflected a desire for greater social inclusion, but did not focus on prevention and health services. Professionals focused on increasing interpersonal skills, people with dementia on normalization, and carers on awareness-raising. CONCLUSIONS: Public health campaigning and education in relation to dementia, could benefit from closer consideration of perspective and age of recipient in intervention design. Interpersonal skills and social inclusion were identified as key issues.

Elder mistreatment, ageism, and human rights.

BACKGROUND: Elder mistreatment, social ageism, and human rights are increasingly powerful discourses in positioning older people in society, yet the relationship between them has rarely been subjected to critical investigation. This perceived relationship will have implications for how mistreatment is understood and responded to. METHOD: Critical gerontological approach based on narrative and textual analysis. RESULTS: Reports of public attitudes toward mistreatment suggest that it is thought to be more common than scientific evidence would suggest; however, reporting is much lower than prevalence. While the discourse over mistreatment has tended to focus on interpersonal relationships, ageism has emphasized social attitudes, and human rights have concentrated on relations between the state and the individual. CONCLUSIONS: In this paper, a series of models have been examined which mark a tendency to restrict and then attempt to reintegrate individual, interpersonal, and social levels of analysis. It is concluded that a focus on the processes of transaction across boundaries rather than contents would facilitate both integrative modeling and deeper understanding of the qualities of abusive situations.

Age, marital status and changes in dietary habits in later life: a 21-year follow-up among Finnish women.

OBJECTIVE: To examine 21-year longitudinal changes in dietary habits and their associations with age and marital status among women aged 50-60 years at baseline. DESIGN: Prospective, longitudinal study of a cohort in the FINMONICA population-based risk factor survey with clinical assessments in 1982, 1992 and 2003. Dietary habits were assessed via self-reported consumption of foods typically contributing to SFA, cholesterol and sugar intakes in the Finnish diet. A dietary risk score based upon five items was used. SETTING: Kuopio region, Finland. SUBJECTS: Complete data from all three assessments for 103 women of the original cohort of 299 were included for two age groups: 50-54 and 55-60 years at baseline. RESULTS: Dietary habits improved between 1982 and 1992 and showed continued but less pronounced improvement between 1992 and 2003: within the younger age group, 78 % of the women reduced the number of dietary risk points from the 1982 to 2003 scores, whereas 3 % increased them and 19 % reported no change. In the older age group these percentages were 61 %, 23 % and 16 %, respectively. Women who remained married showed a steadier decline in dietary risk points than single women or women who were widows at the beginning of the follow-up. CONCLUSIONS: Older women make positive changes to their dietary habits but the consistency of these changes may be affected by the ageing process, marital status and changes in the latter.

Intergenerational Commensality: A Critical Discussion on Non-Familial Age Groups Eating Together.

Connecting intergenerational relationships and commensality has been a neglected area in research and conceptual development within both food and life-course studies. This has been especially true of relations beyond the family. Here, public and private settings are explored in order to examine the relationship between eating together and generationally intelligent empathy. This is to help the discovery of spaces where different generations can interact positively around food and mealtimes. Contemporary social and public health challenges include: to adapt to increased longevity and to build solidarity between generations; to repair the relations between generations arising from institutional segregation; and to increase experiences of generational connection and social inclusion. As age-based cohorts are led to see themselves as separate from each other, we must find ways of building and negotiating new complementary roles for different parts of the life-course. Commensality, eating together at the same table provides an important cultural location and opportunity around which complementary understandings between generations may be built. A new framework is proposed to help identify and critically examine the variables underpinning non-familial intergenerational commensal spaces.

The Project Collection Food, Nutrition and Health, with a Focus on Eating Together.

Papers in this project collection arise from international networking on interdisciplinary research into commensality [...].

Weight loss by mobile phone: a 1-year effectiveness study.

OBJECTIVE: To investigate the short- and long-term effectiveness and the predictors of weight loss in a mobile phone weight-loss programme among healthy overweight adults. DESIGN: One hundred and twenty-five healthy, overweight (BMI = 26-36 kg/m2), 25-44-year-old, screened volunteers were randomized to an experimental group (n 62) to use a mobile phone-operated weight-loss programme or to a control group (n 63) with no intervention. Via text messaging, the programme instructed a staggered reduction of food intake and daily weight reporting with immediate tailored feedback. Assessments were at 0, 3, 6, 9 and 12 months for the experimental group; at 0 and 12 months for the control group. Main outcome variables were changes in body weight and waist circumference. RESULTS: By 12 months the experimental group had lost significantly more weight than the control group (4.5 (sd 5.0) v. 1.1 (sd 5.8) kg; F(1,80) = 8.0, P = 0.006) and had a greater reduction in waist circumference (6.3 (sd 5.3) v. 2.4 (sd 5.4) cm; F(1,80) = 55.2, P = 0.0001). Early weight loss, self-efficacy, contact frequency, attitudes towards the medium, changes in work and family life and changes made in dietary habits were the strongest predictors of weight loss. CONCLUSIONS: This mobile phone weight-loss programme was effective in short- and long-term weight loss. As a minimum-advice, maximal-contact programme, it offers ideas for future weight-loss programmes.

Dementia as a source of social disadvantage and exclusion.

OBJECTIVE: To explore perceptions of the impacts of dementia on people living with the condition and those close to them and examine the relationship between dementia, disadvantage and social exclusion. METHODS: Semi-structured in-depth interviews were conducted with 111 participants: people with dementia (n = 19), carers (n = 28), health-care professionals (n = 21), social workers (n = 23) and service professionals (n = 20). NVivo 11 was used to code descriptions and identify impact areas. RESULTS: Participants described social, psychological, carer, material, service-based and disparity impacts associated with the experience of dementia. Some of these impacts correspond to social exclusion associated with age, but some are distinctive to dementia. DISCUSSION: It is argued that dementia generates its own forms of social disadvantage and exclusion. This is in addition to being subject to structural risk factors. The implications of the active effects of dementia as a social phenomenon should give rise to new policy and practice priorities.

What you say and what I want: Priorities for public health campaigning and initiatives in relation to dementia.

OBJECTIVE: To examine the overlap between priorities expressed by representatives from national and local campaigning organisations and the views of key voices in relation to dementia. METHODS: Semi-structured, in-depth telephone interviews were conducted with 19 representatives from campaigning organisations, including nine countries and six local community initiatives in Australia. Responses were categorised into nine priorities. Views were compared to the voices of people with dementia (n = 19), carers (n = 28), and health-care (n = 21), social work (n = 23) and service professionals (n = 20). RESULTS: Local groups prioritised user-led decision-making and community normalising agendas. National groups were influenced by service frameworks and increasing public awareness. Professional and carer groups focused on increasing understanding and communication skills while people with dementia valued being a normal part of society. CONCLUSION: Future campaigning should use both national and local approaches to changing social relations, through interpersonal connections, advocacy and social mobilisation, to promote a normalising approach to attitude change.