Nordic Studies on Alcohol and Drugs, 2024

The elephant in the room: Metaphors in women’s accounts of life with a family member with problematic substance use

Abstract

Abstract

Background: Research has shown that a family member’s problematic substance use has significant deleterious mental and physical health impacts on other members of the family. Women are more often affected than men. These negative health effects persist as the person with problematic substance use ages, and they vary according to the relationship status.

Aim: The aim of this study was to gain a deeper understanding of how women experience and are affected by their family member’s substance use problems.

Method: A metaphorical analysis of narrative interviews with 11 daughters and five wives of older adults (>65 years) with problematic substance use.

Results: We identified four areas of signification in which metaphors were employed: (1) experiences (chaos and crash and walking on eggshells); (2) strategies (complicity and silencing); (3) dilemmas (deceit or a disease and open or closed dilemmas); and (4) consequences (obtaining or retaining an identity, health and different types of help).

Conclusion: Family life with a parent or spouse with a substance use problem was described as chaotic, unsafe, uncertain and with no prospects of change. The study illustrates how metaphors are used to mediate experiences and worldviews pertaining to existential matters founded in deep negative emotions, deceit, shame and stigma. Metaphors make up a crucial material for communicating emotions and themes that are difficult to convey due to shame and stigma.

Forfattere

Aud Johannessen, Anne-Sofie Helvik, Kjerstin Tevik, Thomas Tjelta, and Kirsten Thorsen

Tilgang til artikkelen

The Journal of Prevention of Alzheimer's Disease, 2024

Female Reproductive Factors and Risk of Mild Cognitive Impairment and Dementia: The HUNT Study

Abstract

Background: More women are living with dementia than men worldwide and there is a need to investigate causes for this female preponderance. While reproductive factors have been investigated as risk factors, the results are conflicting. We aim to clarify this using a large cohort with a long observation time, adjusting for multiple health and lifestyle variables and encompassing a wider range of cognitive impairment.

Objective: To study the association between menopause age, menarche age and risk of and risk of mild cognitive impairment (MCI) and dementia.

Setting: The Trøndelag Health study (HUNT), a longitudinal population health study in Norway (1984–2019).

Participants: Women who were ≥70 years in 2017–2019 were assessed for cognitive impairment.

Measurements: Data on menopause age and menarche age were obtained from questionnaires. Diagnosis of MCI or dementia was set using a standardised procedure by a diagnostic group of nine physicians. Multinomial logistic regression was used to study the association between menopause age, menarche age and risk of MCI and dementia with adjustment for birth year, education, smoking, ApoE4, number of children, diabetes, body mass index, alcohol use and physical inactivity.

Results: We evaluated 5314 women where 900 (16.9%) had dementia, and 1747 (32.8%) had MCI. Multiple adjusted relative risk ratio (RRR) and 95% confidence intervals (CI) for dementia were: 0.96(95%CI 0.95–0.98) (p<0.001) for menopause age, 0.97(95%CI 0.94–0.99) (p=0.007) for natural menopause age (excluding hysterectomy and/or oophorectomy<55 years) and 0.97(95%CI 0.95–0.99) (p<0.001) for reproductive span (menopause age minus menarche age). Menopause age <45years was associated with a 56% higher risk compared to mean menopause age 50 years. We found no significant associations between menarche age and dementia and no associations with MCI.

Conclusions: Older menopause age and longer reproductive span corresponding to longer oestrogen exposure were associated with a lower dementia risk. Future studies should explore therapeutical options to offset this risk in women.

Forfattere

Yehani Wedatilake, C. Myrstad, S. E. Tom, B. H. Strand, S. Bergh & G. Selbæk

Tilgang til artikkelen

SAGE Open Nursing , 2024

Patient-Reported Experiences and Associated Factors in a Norwegian Radiotherapy Setting: An Explorative Cross-Sectional Study

Abstract

Introduction
Radiotherapy is the main treatment modality in cancer. There is sparse knowledge on how patients with cancer experience their radiotherapy trajectory, and which factors might be associated with patients’ experiences.

Objectives
The aim of the present study was to explore how adults with cancer receiving radiotherapy evaluate the quality of their care, utilizing a patient-reported experience measure, and how patient- and service-related characteristics are associated with their evaluation.

Methods
An explorative cross-sectional study using a self-completed questionnaire to assess patients’ radiotherapy experiences was performed. Participants were recruited consecutively, within their last week of treatment, from two different hospitals in Norway from January 2021 to January 2022. Four hundred and eighty paper questionnaires were distributed to recruited patients, 240 at each hospital. Questionnaires were self-completed at home and returned by mail. The instrument person-centered coordinated care experience questionnaire (P3CEQ) was used. In addition to this, participants completed the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and The Sense of Coherence 13 scale (SOC-13). Data were analyzed using descriptive statistics, parametric tests, and unadjusted/adjusted linear regression models were estimated.

Results
The study included 373 patients. Patients evaluated quality of care in terms of P3CEQ scores, with a mean score of 19.5 (standard deviation = 5.4). Lowest scores were identified in areas concerning person-centeredness and service coordination. There were no significant differences in P3CEQ scores between the younger and older groups. Having a partner and better SOC-13 scores were independently associated with the overall patient-reported experience score, whereas age was not.

Conclusion
Patient-reported experience scores indicate that improvements are needed in some areas, such as informing and involving patients in the planning and coordination of their care. Findings suggest paying special attention to patients without a partner to offer patients the best possible care.

Forfattere

May Ingvild Volungholen Sollid, Marit Slaaen, Signe Danielsen, Grethe Eilertsen & Øyvind Kirkevold

Tilgang til artikkelen

Scandinavian Journal of urology, 2024

The association between age and long-term quality of life after curative treatment for prostate cancer: a cross-sectional study

Abstract

Objective: We aimed to investigate the associations between age at radical prostate cancer treatment and long-term global quality of life (QoL), physical function (PF), and treatment-related side effects.

Material and Methods: This single-center, cross-sectional study included men treated for localized pros-tate  cancer  with  robotic-assisted  radical  prostatectomy  (RARP)  or  external  beam  radiotherapy  (EBRT)  in  2014–2018.  Global  QoL  and  PF  were  assessed  by  the  European  Organisation  of  Research  and  Treatment  in Cancer Quality of life Questionnaire-C30 (QLQ-C30), side effects by the Expanded Prostate Cancer Index Composite  (EPIC-26).  Adjusted  linear  regression  models  were  estimated  to  assess  associations  between  age (continuous variable) at treatment and outcomes. QLQ-C30 scores were compared to normative data after dividing the cohort in two groups, <70 years and ≥70 years at treatment.

Results: Of 654 men included, 516 (79%) had undergone RARP, and 138 (21%) had undergone EBRT com-bined with androgen deprivation therapy for 93%. Mean time since treatment was 57 months. Median age at treatment was 68 (min–max 44–84) years. We found no statistically significant independent association between age at treatment and global QoL, PF or side effects, except for sexual function (regression coeffi-cient [RC] −0.77; p < 0.001) and hormonal/vitality (RC 0.30; p = 0.006) function. Mean QLQ-C30 scores were slightly  poorer  than  age-adjusted  normative  scores,  for  men  <70  years  (n  =  411)  as  well  as  for  men  ≥70  years (n = 243) at treatment, but the differences were not beyond clinical significance.

Conclusions: In this cohort of prostate cancer survivors, age at treatment had little impact on long-term QoL and function. Due to the cross-sectional design, short term impact or variation over time cannot be ruled out.

Forfattere

Reidun Sletten, Ola Berger Christiansen, Line Merethe Oldervoll, Lennart Åstrøm, Håvard Kjesbu Skjellegrind, Jūratė Šaltytė Benth, Øyvind Kirkevold, Sverre Bergh, Bjørn Henning Grønberg, Siri Rostoft, Asta Bye, Paul Jarle Mork & Marit Slaaen

Tilgang til artikkelen

Aging & Mental Health, 2024

Caregiver experience of the Norwegian manual for individual cognitive stimulation therapy (iCST): a qualitative study

Abstract

Objectives: This research project investigated how family carers in Norway experienced delivering iCST, their need for supervision and the potential for co-occupation.

Methods: Reflexive thematic analysis was used to understand the experiences of 11 carers using iCST for 8 wk. Three semi-structured interviews were conducted with each participant, including a pre-assessment of caregiver burden and a rating of dementia severity.

Results: Most carers described the manual as self-instructive. Some felt overwhelmed when starting iCST. It was important to plan and individualise the sessions to the specific needs of the person with dementia. After delivering iCST the carers described new insights into the person with dementia’s resources and challenges. Obstacles to doing iCST were related to the context, the manual or to specific challenges linked to the person with dementia or to the carer. Most participants described positive experiences, in which shared interaction, engagement and mastery were common.

Conclusion: When the carer understands the iCST programme as a tool and adapts it to the specific needs of the person with dementia then co-occupation and positive interactions happen. However, some carers would benefit from supervision and the iCST programme did not address all persons with dementia.

Forfattere

Kristine G. Madsø, Rita Weum & Torhild Holthe

Tilgang til artikkelen

Brain and Behavior, 2024

Regional MRI volumetry using NeuroQuant versus visual rating scales in patients with cognitive impairment and dementia

Abstract

Bcakground and purpose
The aims were to compare the novel regional brain volumetric measures derived by the automatic software NeuroQuant (NQ) with clinically used visual rating scales of medial temporal lobe atrophy (MTA), global cortical atrophy-frontal (GCA-f), and posterior atrophy (PA) brain regions, assessing their diagnostic validity, and to explore if combining automatic and visual methods would increase diagnostic prediction accuracy.

Methods
Brain magnetic resonance imaging (MRI) examinations from 86 patients with subjective and mild cognitive impairment (i.e., non-dementia, n = 41) and dementia (n = 45) from the Memory Clinic at Oslo University Hospital were assessed using NQ volumetry and with visual rating scales. Correlations, receiver operating characteristic analyses calculating area under the curves (AUCs) for diagnostic accuracy, and logistic regression analyses were performed.

Results
The correlations between NQ volumetrics and visual ratings of corresponding regions were generally high between NQ hippocampi/temporal volumes and MTA (r = −0.72/−0.65) and between NQ frontal volume and GCA-f (r = −0.62) but lower between NQ parietal/occipital volumes and PA (r = −0.49/−0.37). AUCs of each region, separating non-dementia from dementia, were generally comparable between the two methods, except that NQ hippocampi volume did substantially better than visual MTA (AUC = 0.80 vs. 0.69). Combining both MRI methods increased only the explained variance of the diagnostic prediction substantially regarding the posterior brain region.

Conclusions
The findings of this study encourage the use of regional automatic volumetry in locations lacking neuroradiologists with experience in the rating of atrophy typical of neurodegenerative diseases, and in primary care settings.

Forfattere

Karin Persson, Maria L. Barca, Trine Holt Edwin, Lena Cavallin-Eklund, Gro Gujord Tangen, Hanneke F. M. Rhodius-Meester, Geir Selbæk, Anne-Brita Knapskog og Knut Engedal

Tilgang til artikkelen

BMC Geriatrics, 2024

Exploring the lived experience: impact of dementia diagnosis on individuals with cognitive impairment – a qualitative study

Abstract

Abstract

Objective
Although knowledge about the experience of being diagnosed with dementia is limited, with the expected rise in dementia’s prevalence in the coming decades, such knowledge is pivotal for the people diagnosed, their families, and healthcare planners. Thus, the aim of our study was to explore the experience of living with cognitive impairment and dementia and the impact of being diagnosed with dementia.

Method
A qualitative design was applied. Participants were recruited based on age-adjusted values below ​​threshold values on the Montreal Cognitive Assessment Scale (i.e. 70–79 years, < 22; 80–89 years, < 21; 90 + years, < 20), and the sample ultimately included 15 participants: six with and nine without a documented dementia diagnosis. Qualitative content analysis was performed on the transcribed interviews in four steps to identify codes, categories, and the overall theme.

Results
Three major categories emerged from the interviews: (1) experiences with changes, (2) experiences with being diagnosed with dementia, and (3) existential experience. All participants with and most participants without a dementia diagnosis experienced changes in cognition.

Conclusion
Our findings imply that being diagnosed with dementia is a relief because it explains observed cognitive and functional decreases and reduces confusion, shame and stigma. However, it also raises concerns about an unknown future. Most participants not diagnosed with dementia reported having little or no difficulty with everyday living and leading a fulfilling life. Those findings emphasise the significance of timely versus early diagnosis.

Forfattere

Inger Molvik, Grete Kjelvik, Geir Selbæk & Anne Marie Mork Rokstad

Tilgang til artikkelen

BMC Oral Health, 2024

Oral symptoms in dying nursing home patients. Results from the prospective REDIC study

Abstract

Background
The mouth is a central organ for communication and fluid intake, also for dying nursing home patients. This study describes the prevalence and severity of oral symptoms from nursing home admission until the day of perceived dying and the day of death.

Methods
A prospective, longitudinal cohort study including 696 patients who were admitted to 47 Norwegian nursing homes in 35 municipalities. During the first year of their stay, 189 died (27%), of whom 82 participants were assessed on the day they were perceived as dying and 134 on the day of death. Mouth care, nutrition, and bedsores were assessed with the Residents’ Assessment Instrument for nursing homes (RAI-NH) and palliative care (RAI-PC). Pain intensity was assessed with the Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale (MOBID-2).

Results
The proportion of patients with ≥ 6 oral symptoms increased from 16% when perceived as dying to 20% on the day of death (P = 0.001). On the day of death, xerostomia (66%), dysphagia (59%), and mastication problems (50%) were the most frequently observed oral symptoms. Only 16% received mouth care every hour and 12% were in pain during this procedure. Compared to people without dementia, those with a diagnosis of dementia at admission (N = 112, 86%) had xerostomia and mastication problems more frequently (50% vs. 73%; 32% vs. 56% (P = 0.038), respectively) on the day of death.

Conclusions
The high extent of oral symptoms such as xerostomia, dysphagia, and mastication problems underline the need for systematic assessment and improved oral palliative care for dying nursing home patients with dementia.

Forfattere

Reidun K. N.M. Sandvik, Bettina S. Husebø, Geir Selbæk, Gunhild Strand, Monica Patrascu, Manal Mustafa & Sverre Bergh

Tilgang til artikkelen

Journal of Policy and Practice in Intellectual Disabilities, 2024

Norwegian perspectives on health care for people with intellectual and developmental disabilities

Abstract

Abstract:

The Norwegian health care system is built on individual rights and the principles of universal access, decentralization, and free choice of provider. Norway has universal health coverage, funded primarily by general taxes and by payroll contributions shared by employers and employees. Local authorities at the municipal level organize and finance primary health care services according to local demand and within national frameworks. Habilitation services are offered both in the primary health care and as a part of the specialist health services. They offer both inpatient and outpatient services for people with intellectual/developmental disabilities (IDD). National guidelines, known as Good health and care services for people with IDD, have recently (2021) been launched after various reports over the years of serious breaches and challenges in the health and care services provided to people with IDD.

Forfattere

Stine Skorpen & Erik Søndenaa

Tilgang til artikkelen