Andrea Gilmore-Bykovskyi1,2,3, Shannon Mullen1, Laura Block1, Abigail Jacobs1, Nicole E Werner2,4. 1. School of Nursing Madison, Wisconsin. 2. Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin. 3. Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, Wisconsin. 4. Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
Abstract
BACKGROUND AND OBJECTIVES: Neuropsychiatric symptoms (NPS) are a core feature of Alzheimer's disease and related dementias that are characterized by a fluctuating course. NPS are challenging to manage and contribute to high rates of burden among family caregivers. Successful information exchange between clinicians and family caregivers is critical for facilitating effective management of NPS. However, this communication is often challenging due to inconsistent terminology and classification of symptoms and limited understanding of how family caregivers recognize and describe symptoms. The objective of this study was to examine the language family caregivers' use to describe and contextualize NPS. RESEARCH DESIGN AND METHODS: Descriptive qualitative study of 20 family caregivers in a mostly urban county in the Midwestern United States using semistructured interviews. Caregiver descriptions of NPS were analyzed using directed content and text analysis to examine terminology, followed by a thematic analysis approach to examine contextualization of NPS. RESULTS: Caregivers employed shared terminologies to describe NPS that differed substantially from clinical terminology used to classify symptoms. Caregivers frequently engaged sense-making as a strategy to explain NPS. This sense-making served to contextualize patterns in behavior and was characterized by explanatory, situational, and strategy-oriented frameworks for understanding behavior in terms of its purpose and meaning. Caregivers' descriptions of NPS reflected broad overlap between individual NPS (i.e., agitation and care resistance) that would generally be considered clinically distinct symptoms. DISCUSSION AND IMPLICATIONS: Nomenclature surrounding NPS may vary considerably between family caregivers and clinicians, and should be evaluated in partnership with people with dementia and their caregivers to ensure supportive interventions and resources are responsive to caregivers' interpretation of symptoms and sense-making.
BACKGROUND AND OBJECTIVES: Neuropsychiatric symptoms (NPS) are a core feature of Alzheimer's disease and related dementias that are characterized by a fluctuating course. NPS are challenging to manage and contribute to high rates of burden among family caregivers. Successful information exchange between clinicians and family caregivers is critical for facilitating effective management of NPS. However, this communication is often challenging due to inconsistent terminology and classification of symptoms and limited understanding of how family caregivers recognize and describe symptoms. The objective of this study was to examine the language family caregivers' use to describe and contextualize NPS. RESEARCH DESIGN AND METHODS: Descriptive qualitative study of 20 family caregivers in a mostly urban county in the Midwestern United States using semistructured interviews. Caregiver descriptions of NPS were analyzed using directed content and text analysis to examine terminology, followed by a thematic analysis approach to examine contextualization of NPS. RESULTS: Caregivers employed shared terminologies to describe NPS that differed substantially from clinical terminology used to classify symptoms. Caregivers frequently engaged sense-making as a strategy to explain NPS. This sense-making served to contextualize patterns in behavior and was characterized by explanatory, situational, and strategy-oriented frameworks for understanding behavior in terms of its purpose and meaning. Caregivers' descriptions of NPS reflected broad overlap between individual NPS (i.e., agitation and care resistance) that would generally be considered clinically distinct symptoms. DISCUSSION AND IMPLICATIONS: Nomenclature surrounding NPS may vary considerably between family caregivers and clinicians, and should be evaluated in partnership with people with dementia and their caregivers to ensure supportive interventions and resources are responsive to caregivers' interpretation of symptoms and sense-making.
Authors: Saw-Myo Tun; Daniel L Murman; Heidi L Long; Christopher C Colenda; Alexander von Eye Journal: Am J Geriatr Psychiatry Date: 2007-04 Impact factor: 4.105
Authors: Lee A Jennings; David B Reuben; Leslie Chang Evertson; Katherine S Serrano; Linda Ercoli; Joshua Grill; Joshua Chodosh; Zaldy Tan; Neil S Wenger Journal: J Am Geriatr Soc Date: 2015-02 Impact factor: 5.562
Authors: Nicole E Werner; Barbara Stanislawski; Katherine A Marx; Daphne C Watkins; Marissa Kobayashi; Helen Kales; Laura N Gitlin Journal: Appl Clin Inform Date: 2017-02-22 Impact factor: 2.342
Authors: Willem S Eikelboom; Amy den Teuling; Daphne E Pol; Michiel Coesmans; Sanne Franzen; Lize C Jiskoot; Judy van Hemmen; Ellen H Singleton; Rik Ossenkoppele; Frank Jan de Jong; Esther van den Berg; Janne M Papma Journal: Int J Geriatr Psychiatry Date: 2022-07 Impact factor: 3.850
Authors: Willem S Eikelboom; Najoua Lazaar; Rozemarijn L van Bruchem-Visser; Francesco U S Mattace-Raso; Michiel Coesmans; Rik Ossenkoppele; Esther van den Berg; Janne M Papma Journal: Psychogeriatrics Date: 2022-07-10 Impact factor: 2.295