Dementia reconsidered: the person comes first
TL;DR: The health sector has had its main impact in the area of dementia by providing skills and expertise necessary for comprehensive, holistic assessments, but Kitwood challenges this medical model.
Abstract: Tom Kitwood
Open University Press, £14.95, pp 176
ISBN 0335198554
![][1]
Rating: ![Graphic][2]
The burden of dementia is borne not only by people with dementia, but by their carers, both informal and professional. The major direct financial costs are managed by the welfare sector, through the provision of community services and residential care, whereas indirect costs are largely attributed to informal carers. Advances in care practices would be of considerable benefit. The health sector has had its main impact in the area of dementia by providing skills and expertise necessary for comprehensive, holistic assessments. Kitwood challenges this medical model, which he labels as …
[1]: /embed/graphic-1.gif
[2]: /embed/inline-graphic-1.gif
Citations
More filters
01 Jan 2009
TL;DR: Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients and Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients.
Abstract: OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002
3,716 citations
Cites methods from "Dementia reconsidered: the person c..."
...DCM was developed from the pioneering work of the late Professor Tom Kitwood on person-centred care (Kitwood, 1997)....
[...]
...Instrument Description Dementia care mapping (Kitwood, 1997)....
[...]
New York University1, Bangor University2, Pompeu Fabra University3, University of Arkansas for Medical Sciences4, Hong Kong Polytechnic University5, University College London6, Alzheimer's Association7, Newcastle University8, Karolinska Institutet9, University of New South Wales10, Spanish National Research Council11, Cochrane Collaboration12, University of Washington13
TL;DR: NPTs emerge as a useful, versatile and potentially cost-effective approach to improve outcomes and QoL in ADRD for both the PWD and CG.
Abstract: Introduction: Nonpharmacological therapies (NPTs) can improve the quality of life (QoL) of people with Alzheimer’s disease (AD) and their carers. The objective of this study was to evaluate the best evidence on the effects of NPTs in AD and related disorders (ADRD) by performing a systematic review and meta-analysis of the entire field. Methods: Existing reviews and major electronic databases were searched for randomized controlled trials (RCTs). The deadline for study inclusion was September 15, 2008. Intervention categories and outcome domains were predefined by consensus. Two researchers working together detected 1,313 candidate studies of which 179 RCTs belonging to 26 intervention categories were selected. Cognitive deterioration had to be documented in all participants, and degenerative etiology
834 citations
TL;DR: A KT model, the Critical Realism and the Arts Research Utilization Model (CRARUM), that combines critical realism and arts-based methodologies has the potential to strengthen the science of implementation research by addressing the complexities of practice settings, and engaging potential adopters to critically reflect on existing and proposed practices and strategies for sustaining change.
Abstract: Clinical practice guidelines have been a popular tool for the improvement of health care through the implementation of evidence from systematic research. Yet, it is increasingly clear that knowledge alone is insufficient to change practice. The social, cultural, and material contexts within which practice occurs may invite or reject innovation, complement or inhibit the activities required for success, and sustain or alter adherence to entrenched practices. However, knowledge translation (KT) models are limited in providing insight about how and why contextual contingencies interact, the causal mechanisms linking structural aspects of context and individual agency, and how these mechanisms influence KT. Another limitation of KT models is the neglect of methods to engage potential adopters of the innovation in critical reflection about aspects of context that influence practice, the relevance and meaning of innovation in the context of practice, and the identification of strategies for bringing about meaningful change. This paper presents a KT model, the Critical Realism and the Arts Research Utilization Model (CRARUM), that combines critical realism and arts-based methodologies. Critical realism facilitates understanding of clinical settings by providing insight into the interrelationship between its structures and potentials, and individual action. The arts nurture empathy, and can foster reflection on the ways in which contextual factors influence and shape clinical practice, and how they may facilitate or impede change. The combination of critical realism and the arts within the CRARUM model promotes the successful embedding of interventions, and greater impact and sustainability. CRARUM has the potential to strengthen the science of implementation research by addressing the complexities of practice settings, and engaging potential adopters to critically reflect on existing and proposed practices and strategies for sustaining change.
752 citations
TL;DR: A constructively critical look at some of the assumptions underpinning person-centredness is taken, and a framework describing the potential dimensions of relationship- Centred care is provided, and implications for further development are considered.
Abstract: Currently considerable emphasis is placed on the promotion of person-centred care, which has become a watchword for good practice. This paper takes a constructively critical look at some of the assumptions underpinning person-centredness, and suggests that a relationship-centred approach to care might be more appropriate. A framework describing the potential dimensions of relationship-centred care is provided, and implications for further development are considered.
637 citations
Cites background from "Dementia reconsidered: the person c..."
...…or ‘person-centred’ care reflect the emergence of new approaches to work with older people in a range of care environments, including long-term care (Henderson & Vesperi, 1995), rehabilitation (Nolan et al., 1997), learning disability (Williams & Grant, 1998), and dementia care (Kitwood, 1997)....
[...]
..., 1997), learning disability (Williams & Grant, 1998), and dementia care (Kitwood, 1997)....
[...]
...There are several complex metaphysical and existential arguments underlying the notion of personhood that we do not have the space to rehearse here (but see Kitwood, 1997 for an accessible introduction, and McCormack, 2004)....
[...]
...It is probably in the latter area, following the pioneering work of Tom Kitwood and colleagues at the Bradford Dementia Centre (Kitwood, 1988, 1989, 1990, 1993, 1997; Kitwood & Bredin, 1992a,b; Kitwood & Benson, 1995) that person-centred care has been fully articulated, and there can be little doubt that Kitwood’s ideas have provided a new sense of direction and purpose for practitioners....
[...]
...It is probably in the latter area, following the pioneering work of Tom Kitwood and colleagues at the Bradford Dementia Centre (Kitwood, 1988, 1989, 1990, 1993, 1997; Kitwood & Bredin, 1992a,b; Kitwood & Benson, 1995) that person-centred care has been fully articulated, and there can be little…...
[...]
01 Jan 2019
TL;DR: In this article, a nadalje svakodnevno raditi na prevenciji demencije, osiguravati resurse and osmisljavati strategije borbe protiv demence, to ocekivati pozitivnih pomaka, kako na podrucju terapije, rane dijagnostike, tako i na podrugju rehabilitacije osoba s demencjom.
Abstract: Zakljucno, potrebno je i nadalje svakodnevno raditi na prevenciji demencije, osiguravati resurse i osmisljavati strategije borbe protiv demencije, jer ce broj osoba s demencijom i u Hrvatskoj u buducnosti biti veci. No, s obzirom da se u svijetu ulažu znatna sredstva u podrucju istraživanja demencije, za ocekivati je pozitivnih pomaka, kako na podrucju terapije, rane dijagnostike, tako i na podrucju rehabilitacije osoba s demencijom. Stoga - vrijeme je na nasoj strani!
636 citations