Affordances of the care environment for people with dementia-an assessment study.

BACKGROUND: Evidence on the importance of the physical environment for the well-being of people with dementia has been growing steadily. OBJECTIVE: This article aims to (1) introduce an assessment tool for evaluating the physical care environment for people with dementia; (2) describe the method's initial results and the subsequent feedback provided to the 10 care units; and (3) describe the follow-up results 1 year later. The goal has been to provide care workers and managers with information that affects the well-being of people with dementia and to provide this information on the care environment in the context of their own work environment. METHODS: The assessment was part of a randomized controlled intervention using nonpharmaceutical methods to decrease behavioral and psychological symptoms of people with dementia. During the half-day visits, photographs and field notes were taken, and a final assessment was carried out via the Residential Care Environment Assessment (RCEA) tool developed at the beginning of the study and based on affordance theory. Follow-up data were gathered after 12 months. RESULTS: There were several possibilities for improvements in the provision of residential care in a person-centered environment. Improvements were needed mostly in comfort and in providing opportunities for engagement, activity, and expression of identity. However, in practice, it was difficult to achieve the improvements even with an intensive intervention study. CONCLUSIONS: The authors conclude that the physical care environment involves a complex set of issues and stakeholders in which the impetus to fulfill responsibilities to carry out improvements can easily fall away.

Scripting patienthood with patient clothing.

The potential of care environments to promote patient healing has gained increasing attention over the last decade, with evidence-based designs used to explore developments in this field. Medical textiles, such as clothes provided to patients, are part of the care environment in many countries. Our study focuses on patients' experiences of such clothing. The goal of this research is to understand how patienthood is constructed in relation to patient clothing and the practices around their use. The study is based on four group interviews involving a total of 12 people with experience of being patients in a hospital or of visiting residential care environments. We employed an active interview format, and the medical textiles currently used in Finnish hospitals and residential care facilities were available for scrutiny during the interviews. Content analyses were carried out on the interview transcripts. Patient clothing was critically evaluated by the participants; they experienced giving up their own clothes as akin to a rite of passage into their new role as a patient. The low status of a patient in a hospital environment was symbolised by the outworn appearance of patient clothing and the problems in protecting privacy. Patient clothing was also felt to provide limited possibilities for being active and in some cases was found to be annoying or even harmful and upsetting. For patients, being dressed in patient clothing may be symbolic of lower status and narrowed agency in everyday life. We can conclude that artefacts such as clothing worn in care environments need to be given attention when considering possibilities for improving care.

The effects of postmenopausal hormone therapy on social activity, partner relationship, and sexual life - experience from the EPHT trial.

BACKGROUND: With the exception of sexual functioning and weight, social and behavioural effects of postmenopausal hormone therapy (HT) have not been reported from trials. This paper reports such results from the EPHT-trial in Estonia. METHODS: A randomized trial, with a blind and non-blind sub-trial in Estonia. From 1999-2001, 1778 women were recruited. The mean follow-up was 3.6 years. Women's experiences were asked in the first and final study year by mailed questionnaires (74 and 81% response rates). Comparisons of the groups were made by cross-tabulation and logistic regression, adjusting for age. RESULTS: There were no differences between the HT and non-HT groups in regard to being employed, the extent of social involvement or marital status or opinions on aging. There was no difference in the frequency of free-time exercise, or overweight. Some of the indicators suggested less sexual inactivity, but the differences were small. CONCLUSION: In a trial setting, postmenopausal hormone therapy did not influence work or social involvement or health behaviour.

Inappropriate treatment of people with dementia in residential and day care.

Dependence on the help provided by other people increases the risk of a person being inappropriately treated. Our objective was to investigate inappropriate treatment and its context in the care of people with dementia. Some 85 clients across eight care units providing dementia care were observed by means of a structured Dementia Care Mapping method (DCM). Of the 17 DCM categories for inappropriate treatment, withholding, invalidation, and objectification were the categories coded most frequently. Inappropriate treatment episodes were mostly associated with eating and situations in which a client had a need or request. Most episodes occurred accidentally. The results show that nurses involved in dementia care need more knowledge of how illnesses causing dementia change the way the affected person experiences reality, and of the ethical aspects of their work.

Women's views of the climacteric at the time of low menopausal hormone use, Estonia 1998.

OBJECTIVES: This study examined women's opinions about the climacteric and hormone therapy (HT) after menopause and compared women's and physicians' opinions in a country of low-HT use. METHODS: In 1998, a postal questionnaire was sent to a random sample of 2000 Estonian 45-64-year-old women; 69% (n=1312) responded. In 1999, a postal questionnaire was sent to a random sample of 500 Estonian gynaecologists and general practitioners; 68% (n=342) responded. RESULTS: Mean age at menopause was 49.8 years (S.D. 4.0), and there was no difference by socioeconomic classes or by age in self-rated health. Ten percent of women reported having used HT, with 3% currently using it. Most women reported some symptoms, with vasomotor symptoms more frequently reported by 50-54 years old; women most often reported tiredness (48%). Half of the women but under a fifth of physicians considered the climacteric a normal phase of life. Women's awareness about HT was low and about half had no opinion on its health effects. Half of the women had visited a gynaecologist, older women less so. Women with contacts with health care were more aware of HT. CONCLUSIONS: Women reported symptoms by age-group as similarly found in high-HT use countries and it verifies that many symptoms experienced were not due to menopause. As in other low-HT use countries, women were unfamiliar with HT and their attitudes were traditional, although physicians' attitudes were more positive. Estonian women seemed to have escaped the period of the preventive use of HT.