Transcript Document

The Body in Care:
Experiences of People
with Dementia in a
Residential Care Setting
Sharon Koehn, Ph.D.
Elisabeth Drance, MD, FRCPC
Jean-Francois Kozak, Ph.D.
Canadian Association on Gerontology
Annual Scientific and Educational
Meeting, 3rd November 2007
Outline
• Introducing the
study
• “Three Bodies” in
the literature and
in our data
• Implications
Unique research opportunity
• Management of Challenging Behaviours Through
Physical and Social Environmental Design among
Residents With Dementia
o 20-bed SCU for people with dementia
o Renovation of dining, bathing & patio areas
o Mixed-method study
o Participant observation
o
o
o
o
Clinical measures (CMAI, CIDD, MDS)
Videotaping
Focus groups – staff, family
Interviews – residents, staff, family
The three bodies
Scheper-Hughes and Lock (1987)
“advocate the deconstruction of received
concepts about the body and begin this process
by examining three perspectives from which the
body may be viewed: (1) as a phenomenologically experienced individual body-self; (2)
as a social body, a natural symbol for thinking
about relationships among nature, society, and
culture; and (3) as a body politic, an artefact of
social and political control.”
Dementia Care Mapping
A person-centered approach to dementia care that
focuses on the interdependency of the quality of the care
environment and the relative quality of life experienced
by people with dementia. Trained observers record
• Quality of Life elements:
o
o
o
o
Relative well-being
Affect
Engagement
Occupation
• Quality of care practice as it promotes or undermines
personhood
Merleau-Ponty’s body-subject
• The person ≠ consciousness alone, but
also the body
o Also has an impact on subjectivity
o Demands that we pay attention to the
environment – personhood can be maintained
by attention to surroundings (need to be
humane and homelike)
Person-environment interaction
• Optimal stimulation and meaningful activity
• Human contact
• Safety and supervision
• Individual care
• Flexibility
Interpreting the body-subject
“The ageless self
maintains continuity
•
How
does
the
person
through a symbolic,
with dementia
creative process. The
continue to create
self draws meaning
meaning?
from the past,
• What does the body
interpreting and
communicate about
recreating it as a
that creative process?
resource for being in
the present” (Kaufman,
1986:13-14)
The lived body in dementia
• Phinney & Chesla (2003):
o Interpretive phenomenological analysis to
reveal how dementia symptoms are
experienced in and through the lived body
o Sample: community-living people with mildmoderate dementia
o Embodied knowledge breaks down →
reflective stance (think it through) →
disorganization → blank (world devoid of
meaning)
Summing Up: Individual Body
• Talking is not the only form of
communication
• Alternative modes include singing, body
language, touch …
• Pre-dementia, these are culture-specific; is
this true as the dementia progresses?
The social body
“The body has no intrinsic meaning.
Populations create their own meanings and thus
their own bodies; but how they create, and then
change them, and why, reflects the social body”
(Synnott, 1992)
“Just as bodily changes are felt immediately in
the metaphoric process of thought, so the
intentional nature of metaphor ensures that
thoughts may be felt immediately in the body”
(Kirmayer 1992:336).
Old, “demented” bodies
• In Western culture,
old bodies are often
stigmatized;
considered, for the
most part, as
undesirable,
metaphors of
breakdown and
decreased social
status
• “The needs of the
physical body are
used by carers to
define the social body
of the elderly person.
… Lost physical
abilities [mean] lost
adult social status as
Mr or Mrs” (Hockey &
James, 1995, p. 141)
Recognition of the social body
• Our observations:
o Person vs Pathology Perspectives
o Social Status of “Elderly Person”
o Task and Time Focus vs. Nurturing and
Enabling
• Important to credit staff efforts to challenge
these culturally grounded constructions
The Political Body
• Refers “to the regulation, surveillance and
control of bodies (individual and collective)
in reproduction and sexuality, in work and
leisure, in sickness and other forms of
deviance and human difference” (ScheperHughes and Lock, 1987, pp. 7-8).
• Differences in cognitive status “justify”
containment of seniors with dementia in
secure units.
Under-resourcing of LTC
“Government and administrative
inattention to issues of sufficient funding
for staff, relationship needs and continuity
of care for seniors threatened to
undermine residents' experiences of
meaning, as well as any potential benefits
from facilities and program improvements”
(Coughlan and Ward, 2006, p. 391).
Systemic constraints
• Use of casual staff usually not have ongoing
relationships with residents
• Sick leave is frequently sought as a means of
offsetting work stress
• Work stress → emotional withdrawal by staff →
objectification & task focus
• Need for policies and procedures that promote
person enablement
Intersecting bodies
Individual
Body
Social Body Political Body
References Cited (1)
Brooker, D. (2005). Dementia care mapping: A review of the research literature.
The Gerontologist, 45 Spec No 1(1), 11-18.
Coughlan, R., & Ward, L. (2006). Experiences of recently relocated residents of
a long-term care facility in Ontario: Assessing quality qualitatively.
International journal of nursing studies,
Hockey, J. & James, A. (1995), Back to Our Futures: Imaging Second
Childhood. In Featherstone, M. & Wernick, A. (Eds.), Images of Aging:
Cultural Representations of Later Life. Pp. 135-48. London; New York:
Routledge.
Hughes, J., Louw, S., & Sabat, S. R. (2006). Seeing Whole. In Hughes J. C.,
Louw S. J. and Sabat S. R. (Eds.), Dementia : Mind, meaning, and the
person. Pp. 1-39. Oxford; Toronto: Oxford University Press.
Kaufman, S.R. (1986). The Ageless Self: Sources of Meaning in Late Life.
Madison, Wisconsin: University of Wisconsin Press.
Kendell, R. E. (2001). The distinction between mental and physical illness. The
British journal of psychiatry : the journal of mental science, 178, 490-493.
References Cited (2)
Kendler, K. S. (2001). A psychiatric dialogue on the mind-body problem. The
American Journal of Psychiatry, 158(7), 989-1000.
Kirmayer, L.J. (1992). The Body’s Insistence on Meaning: Metaphor as
Presentation and Representation in Illness Experience. Medical
Anthropology Quarterly 6 (4):323-46.
Morgan, D.G., & Stewart, N.J. (1997). The importance of the social
environment in Dementia care. Western Journal of Nursing Research,
19(6), 740-761.
Phinney, A., & Chesla, C. A. (2003). The lived body in dementia. Journal of
Aging Studies, 17(3), 283-299.
Scheper-Hughes, N., & Lock, M. M. (1987). The mindful body: A prolegomenon
to future work in medical anthropology. Medical anthropology quarterly,
1(1), 6-41.
Synnott, A. (1992). Tomb, Temple, Machine and the Self: The Social
Construction of the Body. British Journal of Sociology 43 (1):79-110.
E-mail & Web
Contact
[email protected]
Presentation available at
www.centreforhealthyaging.ca
Thank you!