Journal of Nursing and Healthcare of Chronic Illness, 2000
Older people maintaining mental health well-being through resilience: an appreciative inquiry stu... more Older people maintaining mental health well-being through resilience: an appreciative inquiry study in four countries Abstract Aim. To explore the experience and strategies of mental health well-being through resilience in older people across the four participating countries.
To explore the perceptions of loneliness according to people with early-stage dementia, living in... more To explore the perceptions of loneliness according to people with early-stage dementia, living in community and long-term care and also the views of their family carers. Research that specifically explores the influence of loneliness on dementia is limited and indicates the prevalence of loneliness and the negative relationship between loneliness and cognitive decline. There is a paucity of research that explores loneliness from the perspective of the person with dementia. A descriptive exploratory qualitative approach was used. Data were collected through semi-structured audio-taped interviews. A purposive sample of 70 people with a diagnosis or probable dementia and 73 family carers were recruited from community and long-term care from South East Queensland, Australia. Four themes were identified: staying connected to others; losing the ability to socially engage; experiencing loneliness; and overcoming loneliness. The results emphasise the importance of familiar human relationships in reducing the feelings of loneliness in people experiencing dementia. People with dementia are at risk of loneliness, but placing them with unfamiliar people and environments may not improve their situation. Better refinement of care that takes into account the potential for loneliness and an understanding of premorbid social tendency may assist in the implementation of individualised and evidence-based strategies to assist people with dementia to lead a better quality of life. To maintain well-being, the social needs of the person with dementia as well as the family need to be considered.
This Australian study explored management for older people with dementia in an acute hospital set... more This Australian study explored management for older people with dementia in an acute hospital setting. As the population ages, increasing numbers of older people with dementia are placed into an acute care hospital to manage a condition other than dementia. These people require special care that takes into account the unique needs of confused older people. Current nursing and medical literature provides some direction in relation to best practice management; however, few studies have examined this management from the perspective of hospital staff. A descriptive qualitative approach was used. Data were collected using semi-structured audio-taped interviews with a cross section of thirteen staff that worked in acute medical or surgical wards in a large South East Queensland, Australia Hospital. Analysis of data revealed five subthemes with the overarching theme being paradoxical care, in that an inconsistent approach to care emphasised safety at the expense of well-being and dignity. A risk management approach was used rather than one that incorporated injury prevention as one facet of an overall strategy. Using untrained staff to sit and observe people with dementia as a risk management strategy does not encourage an evidence-based approach. Staff education and environmental resources may improve the current situation so that people with dementia receive care that takes into account their individual needs and human dignity. Nurses can assist older people with dementia by encouraging evidence-based care practices to become the part of hospital policy.
Aims and objectives. This study sought to compare two well-known and well-used self-report qualit... more Aims and objectives. This study sought to compare two well-known and well-used self-report quality of life questionnaires in terms of completion rates, reliability and assessment of quality of life. Background. People with dementia have a meaningful experience of quality of life and several disease-specific instruments have been designed to capture self-report assessments. Design. A quantitative survey design, with a convenience sample of older people with dementia from four long-term care facilities.
To explore perceptions of a self-help print-delivered intervention aimed at encouraging social we... more To explore perceptions of a self-help print-delivered intervention aimed at encouraging social well-being and addressing loneliness in a retirement village community. A total of 58 residents of an Australian retirement village received a series of five factsheets addressing various dimensions of loneliness. The factsheets raised awareness of the importance of social well-being and loneliness. However, the approach was considered difficult to update and was not appropriate for those from a non-English speaking background or with vision impairments. The non-face-to-face approach also was unable to address issues of loneliness associated with bereavement. This form of intervention offers a cost-effective way to raise awareness of loneliness and social well-being in a retirement village community when issues of updating and presentation of information are taken into consideration.
Frontotemporal dementia (FTD) is reportedly highly heritable, even though a recognized genetic ca... more Frontotemporal dementia (FTD) is reportedly highly heritable, even though a recognized genetic cause is often absent. To explain this contradiction, we explored the "strength" of family history in FTD, Alzheimer's disease (AD), and controls. Clinical syndromes associated with heritability of FTD and AD were also examined. FTD and AD patients were recruited from an FTD-specific research clinic, and patients were further sub-classified into FTD or AD phenotypes. The strength of family history was graded using the Goldman score (GS), and GS of 1-3 was regarded as a "strong" family history. A subset of FTD patients underwent screening for the main genetic causes of FTD. In total, 307 participants were included (122 FTD, 98 AD, and 87 controls). Although reported positive family history did not differ between groups, a strong family history was more common in FTD (FTD 17.2 %, AD 5.1 %, controls 2.3 %, P < 0.001). The bvFTD and FTD-ALS groups drove heritability, but 12.2 % of atypical AD patients also had a strong family history. A pathogenic mutation was identified in 16 FTD patients (10 C9ORF72 repeat expansion, 5 GRN, 1 MAPT), but more than half of FTD patients with a strong family history had no mutation detected. FTD is a highly heritable disease, even more than AD, and patients with bvFTD and FTD-ALS drive this heritability. Atypical AD also appears to be more heritable than typical AD. These results suggest that further genetic influences await discovery in FTD.
Journal of Nursing and Healthcare of Chronic Illness, 2000
Older people maintaining mental health well-being through resilience: an appreciative inquiry stu... more Older people maintaining mental health well-being through resilience: an appreciative inquiry study in four countries Abstract Aim. To explore the experience and strategies of mental health well-being through resilience in older people across the four participating countries.
To explore the perceptions of loneliness according to people with early-stage dementia, living in... more To explore the perceptions of loneliness according to people with early-stage dementia, living in community and long-term care and also the views of their family carers. Research that specifically explores the influence of loneliness on dementia is limited and indicates the prevalence of loneliness and the negative relationship between loneliness and cognitive decline. There is a paucity of research that explores loneliness from the perspective of the person with dementia. A descriptive exploratory qualitative approach was used. Data were collected through semi-structured audio-taped interviews. A purposive sample of 70 people with a diagnosis or probable dementia and 73 family carers were recruited from community and long-term care from South East Queensland, Australia. Four themes were identified: staying connected to others; losing the ability to socially engage; experiencing loneliness; and overcoming loneliness. The results emphasise the importance of familiar human relationships in reducing the feelings of loneliness in people experiencing dementia. People with dementia are at risk of loneliness, but placing them with unfamiliar people and environments may not improve their situation. Better refinement of care that takes into account the potential for loneliness and an understanding of premorbid social tendency may assist in the implementation of individualised and evidence-based strategies to assist people with dementia to lead a better quality of life. To maintain well-being, the social needs of the person with dementia as well as the family need to be considered.
This Australian study explored management for older people with dementia in an acute hospital set... more This Australian study explored management for older people with dementia in an acute hospital setting. As the population ages, increasing numbers of older people with dementia are placed into an acute care hospital to manage a condition other than dementia. These people require special care that takes into account the unique needs of confused older people. Current nursing and medical literature provides some direction in relation to best practice management; however, few studies have examined this management from the perspective of hospital staff. A descriptive qualitative approach was used. Data were collected using semi-structured audio-taped interviews with a cross section of thirteen staff that worked in acute medical or surgical wards in a large South East Queensland, Australia Hospital. Analysis of data revealed five subthemes with the overarching theme being paradoxical care, in that an inconsistent approach to care emphasised safety at the expense of well-being and dignity. A risk management approach was used rather than one that incorporated injury prevention as one facet of an overall strategy. Using untrained staff to sit and observe people with dementia as a risk management strategy does not encourage an evidence-based approach. Staff education and environmental resources may improve the current situation so that people with dementia receive care that takes into account their individual needs and human dignity. Nurses can assist older people with dementia by encouraging evidence-based care practices to become the part of hospital policy.
Aims and objectives. This study sought to compare two well-known and well-used self-report qualit... more Aims and objectives. This study sought to compare two well-known and well-used self-report quality of life questionnaires in terms of completion rates, reliability and assessment of quality of life. Background. People with dementia have a meaningful experience of quality of life and several disease-specific instruments have been designed to capture self-report assessments. Design. A quantitative survey design, with a convenience sample of older people with dementia from four long-term care facilities.
To explore perceptions of a self-help print-delivered intervention aimed at encouraging social we... more To explore perceptions of a self-help print-delivered intervention aimed at encouraging social well-being and addressing loneliness in a retirement village community. A total of 58 residents of an Australian retirement village received a series of five factsheets addressing various dimensions of loneliness. The factsheets raised awareness of the importance of social well-being and loneliness. However, the approach was considered difficult to update and was not appropriate for those from a non-English speaking background or with vision impairments. The non-face-to-face approach also was unable to address issues of loneliness associated with bereavement. This form of intervention offers a cost-effective way to raise awareness of loneliness and social well-being in a retirement village community when issues of updating and presentation of information are taken into consideration.
Frontotemporal dementia (FTD) is reportedly highly heritable, even though a recognized genetic ca... more Frontotemporal dementia (FTD) is reportedly highly heritable, even though a recognized genetic cause is often absent. To explain this contradiction, we explored the "strength" of family history in FTD, Alzheimer's disease (AD), and controls. Clinical syndromes associated with heritability of FTD and AD were also examined. FTD and AD patients were recruited from an FTD-specific research clinic, and patients were further sub-classified into FTD or AD phenotypes. The strength of family history was graded using the Goldman score (GS), and GS of 1-3 was regarded as a "strong" family history. A subset of FTD patients underwent screening for the main genetic causes of FTD. In total, 307 participants were included (122 FTD, 98 AD, and 87 controls). Although reported positive family history did not differ between groups, a strong family history was more common in FTD (FTD 17.2 %, AD 5.1 %, controls 2.3 %, P < 0.001). The bvFTD and FTD-ALS groups drove heritability, but 12.2 % of atypical AD patients also had a strong family history. A pathogenic mutation was identified in 16 FTD patients (10 C9ORF72 repeat expansion, 5 GRN, 1 MAPT), but more than half of FTD patients with a strong family history had no mutation detected. FTD is a highly heritable disease, even more than AD, and patients with bvFTD and FTD-ALS drive this heritability. Atypical AD also appears to be more heritable than typical AD. These results suggest that further genetic influences await discovery in FTD.
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Papers by Natalie Gracia