When Ambiguous Loss Becomes Ambiguous Grief: Clinical Work with Bereaved Dementia Caregivers

2020 ◽  
Author(s):  
Abigail Nathanson ◽  
Madeline Rogers
Keyword(s):  
Social Support ◽  
Family Functioning ◽  
Clinical Work ◽  
Ambiguous Loss ◽  
Dementia Caregivers ◽  
Dementia Caregiving ◽  
Person With Dementia

Abstract The experience of caring for someone with dementia can be heartbreaking. The losses inherent to caregiving itself can be difficult to reconcile after the death of a person with dementia, causing challenges in the bereavement stage. Although there is often significant social support to help people process the death of someone close to them, clinicians can struggle to help bereaved dementia caregivers integrate their ambiguous losses from caregiving, such as loss of roles, functions, and relationships, into a postdeath bereavement process. Many socioeconomic, personality, and family functioning factors impact an individual caregiver’s experience, and there are more global influences from the nature of dementia caregiving itself that must be understood to best support a caregiver. Using the lens of the dementia grief model and examples from a case study, this article seeks to illustrate the dynamics inherent in integrating ambiguous losses following the death of a person from dementia, and it proposes clinical goals for working effectively with this population.

scholarly journals “Locked Out of Caregiving”: A Case Study of Dementia Caregiving During the Covid-19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 805-806
Author(s):  
Kristie Wood ◽  
Marie-Anne Suizzo
Keyword(s):  
Family System ◽  
Care Center ◽  
Adult Child ◽  
Ambiguous Loss ◽  
Dementia Caregivers ◽  
Dementia Caregiving ◽  
Coping Processes ◽  
Memory Care ◽  
And Coping

Abstract It is unclear how ambiguous loss in dementia caregiving is impacted by conditions of the Covid-19 pandemic. Ambiguous loss describes situations in which closure is impossible and ambiguities within a family system ensue. Two situations of ambiguous loss exist. In the first type, one is psychologically absent, yet physically present, e.g. when one has dementia. In the second type, one is physically absent but psychologically present, e.g. moving to a nursing home. Ambiguous loss theory was applied to longitudinal interviews with an adult-child caregiver (age=52) of a mother with dementia, who resided in memory care during the Covid-19 pandemic. Theoretical analysis revealed both types of ambiguous loss were experienced in the dementia caregiving relationship. This was embedded within ambiguous loss type 2 due to the Covid-19 pandemic, e.g. social distancing and quarantine practices led to physical estrangement from others and ambiguity ensued about when, or if, estrangement would end before resulting in death. Further, the coping mechanisms defined in the ambiguous loss framework: restructuring identity, finding meaning, gaining mastery, increasing ambivalence capacity, reframing attachments, and gaining hope, were compromised due to overarching ambiguous loss attributed to the pandemic. Continued panic and frustration regarding lack of communication with and access to the memory care center instilled a sense of being “locked out of caregiving.” Findings suggest dementia caregivers may experience both types of ambiguous loss compounded during the Covid-19 pandemic, suspending grief and coping processes, and inciting poorly understood needs and challenges that must be better understood to support dementia caregivers.

scholarly journals Objective and Subjective Dementia Caregiving Burden: The Moderating Role of Immanent Justice Reasoning and Social Support

2020 ◽  
Vol 17 (2) ◽  
pp. 455 ◽  
Author(s):  
Yanchun Cao ◽  
Fan Yang
Keyword(s):  
Social Support ◽  
Rating Scale ◽  
Meaning Making ◽  
Short Version ◽  
Physical And Mental Health ◽  
Subjective Burden ◽  
Dementia Caregivers ◽  
Cross Sectional ◽  
Caregiving Burden ◽  
Dementia Caregiving

Caregiving burden significantly effects the physical and mental health of family dementia caregivers. While the association between objective caregiving burden (OCB) and subjective caregiving burden (SCB) of family dementia caregivers is well documented, little is known as with how the association is moderated by the configuration of intrapersonal resource (e.g., immanent justice reasoning) and interpersonal resource (e.g., social support). The present study collected cross-sectional data on 157 major family caregivers of non-institutionalized persons with dementia in an urbanizing region of Western China’s Sichuan Province. They responded to questions on daily time spent on caregiving, the short version of Zarit Burden Interview (ZBI), a sub-scale of a caregiver meaning scale, Social Support Rating Scale (SSRS), and demographic questions. Controlling for the demographic variables of the caregivers, this study found that the objective and subjective dementia caregiving burden were significantly associated (p < 0.001), and immanent justice reasoning was positively correlated with subjective burden (p < 0.01). Moreover, the association between OCB and SCB was significantly positive when social support and immanent justice reasoning were both high (p < 0.001), but neutral when social support was high and immanent justice reasoning was low. The association between OCB and SCB was significantly positive when social support and immanent justice reasoning were both low (p < 0.05), but neutral when social support was low and immanent justice reasoning was high. This research suggests the importance of developing intervention programs that consider the configuration of the external supporting resources and internal meaning-making of caregiving of the family dementia caregivers.

Can drawings help assessing dementia caregivers' burden? A preliminary study

Dementia ◽  
2018 ◽  
Vol 19 (3) ◽  
pp. 661-675 ◽  
Author(s):  
Perla Werner ◽  
Hanan AboJabel
Keyword(s):  
Physical Disability ◽  
Minority Groups ◽  
Elderly Person ◽  
Self Report ◽  
Dementia Caregivers ◽  
Dementia Caregiving ◽  
Gender And Age ◽  
Israeli Arabs ◽  
Preliminary Study ◽  
Person With Dementia

The use of quantitative self-report methods for assessing the stress associated with dementia caregiving, especially among minority groups, has been lately criticized. The aim of this study was to examine whether Human Figures Drawings might provide a tool for assessing caregivers' burden. Sixty Israeli Arabs – 30 family caregivers of a person with dementia and 30 gender and age-matched non-caregivers – were asked to draw a caregiver of an elderly person with dementia and a caregiver of an elderly person with a physical disability. While no differences were found between the drawings of caregivers and non-caregivers, statistically significant differences were found between all the characteristics of the drawings depicting a caregiver of an elderly person with dementia and a caregiver of an elderly person with a physical disability, as drawn by caregivers. Several of the drawings' characteristics were significantly associated with caregiver burden. By introducing a nonverbal form of expression, Human Figures Drawings might add utility to the assessment of dementia caregivers' burden.

scholarly journals DEVELOPING A CONCEPTUAL MODEL OF FAMILY PREPAREDNESS FOR FUTURE DEMENTIA CAREGIVING IN CHINESE FAMILIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S467-S467
Author(s):  
Jacky C P Choy
Keyword(s):  
Family Involvement ◽  
Family Members ◽  
Influential Factors ◽  
Spousal Caregivers ◽  
Chinese Society ◽  
Dementia Caregivers ◽  
Chinese Families ◽  
Dementia Caregiving ◽  
The Family ◽  
Person With Dementia

Abstract Dementia is a growing health challenge that demands better public preparedness. Persons with dementia often lack the capacity to make and execute plans such that family involvement in care preparation becomes necessary. It is commonly observed in Chinese societies that there are more than one family members involved in the taking care of the person with dementia. The current qualitative study aims to understand preparedness for dementia caregiving of a family as unit in a Chinese society. In-depth interviews with 10 family units of dementia caregivers were conducted. Participants (4 spousal caregivers; 44 to 80 years old; mean years of caregiving: 3.3) reflected on how prepared their families were before the caregiving began. Thematic analysis was applied to examine the family preparedness and the family dynamics throughout the caregiving journey. As opposed to a crisis-driven involvement, involvement of more family members before crisis was helpful for reducing the damage brought to the family. Furthermore, families that could align their expectation and understanding of the situation, share knowledge and resources, negotiate the allocation of caregiving duties, and provide emotional support among family members were more likely to provide proper care with minimal sacrifice in family wellbeing. Chinese families often worked as a caregiving team, yet, with uneven distribution of caregiving duties and a lack of proper communication to sustain their caregiving role healthily. Timing and quality of family involvement were more influential factors than family resources to successful adaptation to caregiving.

A Case Study of a Large and Rare Pleomorphic Liposarcoma in The Chest Area

2020 ◽  
Author(s):  
Yuanjun Cheng
Keyword(s):  
Delayed Diagnosis ◽  
Clinical Work ◽  
Radical Excision ◽  
Pathological Findings ◽  
Chest Tightness ◽  
Pleomorphic Liposarcoma ◽  
Left Chest ◽  
Specific Symptoms ◽  
Work Up

Pleomorphic liposarcoma rarely develops in the chest area. This report presents a primary pleomorphic liposarcoma that was discovered in the left chest area of a 74-year-old female patient. The patient had presented specific symptoms, including cough, chest tightness and shortness of breath. A radical excision of the tumor was performed. The tumor was extremely large (27 cm - 24 cm- 10 cm) and completely encapsulated. Upon histological examination, it was diagnosed as a giant, pleomorphic liposarcoma. Thereafter, non-specific radiological and endoscopic results during clinical work-up delayed diagnosis until post-operative histology were gathered. In this report, the case-specific clinical and radiological diagnostic challenges are discussed, as well as the relevant surgical and pathological findings.

scholarly journals Childhood Trauma and Psychological Distress: A Serial Mediation Model among Chinese Adolescents

2021 ◽  
Vol 18 (13) ◽  
pp. 6808
Author(s):  
Lin Zhang ◽  
Xueyao Ma ◽  
Xianglian Yu ◽  
Meizhu Ye ◽  
Na Li ◽  
...  
Keyword(s):  
Social Support ◽  
Family Functioning ◽  
Childhood Trauma ◽  
Chinese Adolescents ◽  
Mediation Model ◽  
Southeast China ◽  
General Distress ◽  
Long Time ◽  
Serial Mediation ◽  
Support Family

The consequence of childhood trauma may last for a long time. The purpose of the present study was to examine the effect of childhood trauma on general distress among Chinese adolescents and explore the potential mediating roles of social support and family functioning in the childhood trauma-general distress linkage. A total of 2139 valid questionnaires were collected from two high schools in southeast China. Participants were asked to complete the questionnaires measuring childhood trauma, social support, family functioning, and general distress. Pathway analysis was conducted by using SPSS AMOS 24.0 and PROCESS Macro for SPSS 3.5. Results showed that childhood trauma was positively associated with general distress among Chinese adolescents. Social support and family functioning independently and serially mediated the linkage of childhood trauma and general distress. These findings confirmed and complemented the ecological system theory of human development and the multisystem developmental framework for resilience. Furthermore, these findings indicated that the mental and emotional problems of adolescents who had childhood trauma were not merely issues of adolescents themselves, but concerns of the whole system and environment.

scholarly journals Coaches’ implementation strategies in providing social support to Singaporean university athletes: A case study

2019 ◽  
Vol 14 (5) ◽  
pp. 681-693
Author(s):  
Koon Teck Koh ◽  
Marja Kokkonen ◽  
Heng Rang Bryan Law
Keyword(s):  
Social Support ◽  
Implementation Strategies ◽  
Well Being ◽  
Implementation Framework ◽  
Support Strategies ◽  
Individual Sports ◽  
Sport Coaches ◽  
University Athletes

Coaches are effective providers of social support to their athletes. Although sport-specific measures of social support have been developed to better understand athletes’ perceptions of available support, limited amount of research has addressed how sport coaches implement specific social support strategies. The purpose of this study was to examine university coaches’ implementation strategies in providing various forms of social support to their athletes. A total of eight sport coaches from team and individual sports (four from each sport) were purposefully selected for this study. Coaches were individually interviewed. The interview transcripts were analysed using a thematic analysis. The results revealed that coaches from different sports shared similar strategies across emotional, esteem, informational and tangible dimensions, but with some distinguishable differences in the way these strategies were implemented. In documenting the lived experiences of sport coaches, key strategies valued highly among these coaches were highlighted, providing important implications for coaches to know how to incorporate these strategies into their coaching practice to better support athletes’ well-being and improve the quality of coaching. The findings also provide an implementation framework of social support that emphasizes key strategies for coaches to focus on in their coaching approaches.

scholarly journals Dementia grief: A theoretical model of a unique grief experience

Dementia ◽  
2016 ◽  
Vol 16 (1) ◽  
pp. 67-78 ◽  
Author(s):  
Kesstan Blandin ◽  
Renee Pepin
Keyword(s):  
Applied Research ◽  
Theoretical Models ◽  
Therapeutic Interventions ◽  
Dementia Caregivers ◽  
Psychological States ◽  
Grief Process ◽  
High Prevalence ◽  
Research Questions ◽  
Stress Burden ◽  
Person With Dementia

Previous literature reveals a high prevalence of grief in dementia caregivers before physical death of the person with dementia that is associated with stress, burden, and depression. To date, theoretical models and therapeutic interventions with grief in caregivers have not adequately considered the grief process, but instead have focused on grief as a symptom that manifests within the process of caregiving. The Dementia Grief Model explicates the unique process of pre-death grief in dementia caregivers. In this paper we introduce the Dementia Grief Model, describe the unique characteristics of dementia grief, and present the psychological states associated with the process of dementia grief. The model explicates an iterative grief process involving three states— separation, liminality, and re-emergence—each with a dynamic mechanism that facilitates or hinders movement through the dementia grief process. Finally, we offer potential applied research questions informed by the model.

Families: A Link or a Liability?

1991 ◽  
Vol 2 (2) ◽  
pp. 252-257 ◽  
Author(s):  
Barbara J. Kupferschmid ◽  
Tess L. Briones ◽  
Carrie Dawson ◽  
Cheryl Drongowski
Keyword(s):  
Social Support ◽  
Family Support ◽  
Care Setting ◽  
Normal Family ◽  
Stressful Situation ◽  
Family Needs ◽  
Family Coping ◽  
Case Study Analysis ◽  
Social Support Systems

Hospitalization in a critical care setting has multiple effects on patients and their families. For patients, it can be a frightening and dehumanizing experience, while families are confronted with stressors that can disrupt normal family functioning. The nurse is the pivotal figure in the health care system who can positively affect family coping through the support offered. With family needs met, they are then strengthened and able to support their family member. This article examines the roles and relationships of families, social support systems, and nurses. Through the framework of social support, nurses provide emotional, instrumental, spiritual, and appraisal assistances to families. This can potentially positively affect the family’s adaptation to a stressful situation, and thus the family’s ability to provide support to the patient. A case study analysis is described to illustrate the interactions and interventions through a model of family support

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