Department of Public Health, 6174University of Southern Denmark, Syddanmark, Denmark.
Centre for Nutrition and Rehabilitation, 165104Absalon University College, Sjælland, Denmark.
Dementia (London). 2022 Oct;21(7):2210-2230. doi: 10.1177/14713012221117412. Epub 2022 Aug 3.
Due to its goal-orientation, rehabilitation may be considered a future-oriented practice. As rehabilitation is increasingly recognized as contributing to dementia care it is important to explore how rehabilitation corresponds with the future orientation of older people with dementia.The aim of this study was to explore the futurework of home-dwelling people with mild to moderate dementia in the context of rehabilitation-focused municipal dementia care, that is, their thinking and practices regarding their future and how these correspond with institutionalized practices.The study was conducted as a case-study inspired by the methodology of Institutional Ethnography (IE). The study setting was two Danish municipalities sampled as a paradigmatic case. Eight older people living with early-stage dementia (mean age: 78 years, age range: 65-91) were strategically sampled and each interviewed recurringly within a period of six through 15 months. In total, 29 interviews were completed. An abductive analysis was subsequently conducted based on these interviews.Findings included three dimensions of futurework: Extending the present state into the near future; avoiding being confronted with an anticipated future; and adjusting to decline and preparing for future losses. Based on these findings, a notion of 'ambivalent futurework' is suggested. The futurework of older people did not always correspond with the institutional arrangements in a rehabilitation-focused dementia care. Findings show that the institutional arrangements in dementia care may support as well as challenge the futurework of the participants. Paying attention to the ambivalences of older people living with dementia and recognizing the ambivalent futurework may be essential in rehabilitation-focused dementia care.
由于其目标导向，康复可以被视为一种面向未来的实践。随着康复越来越被认为有助于痴呆症护理，探索康复如何与痴呆症老年人的未来取向相对应变得尤为重要。本研究的目的是探讨在以康复为重点的市立痴呆症护理背景下，轻度至中度痴呆症的居家者的未来工作，即他们对未来的思考和实践，以及这些思考和实践如何与机构化实践相对应。本研究是作为受制度民族志（IE）方法论启发的案例研究进行的。研究地点是两个丹麦市，作为范例案例进行抽样。从轻度到中度痴呆症的 8 名老年人（平均年龄：78 岁，年龄范围：65-91 岁）被有策略地抽样，并在 6 至 15 个月的时间内进行反复访谈。共完成了 29 次访谈。随后根据这些访谈进行了归纳分析。研究结果包括未来工作的三个维度：将当前状态延伸到不久的将来；避免面对预期的未来；以及适应衰退和为未来的损失做准备。基于这些发现，提出了“矛盾的未来工作”的概念。老年人的未来工作并不总是与以康复为重点的痴呆症护理中的制度安排相对应。研究结果表明，痴呆症护理中的制度安排可能会支持和挑战参与者的未来工作。关注患有痴呆症的老年人的矛盾情绪，并认识到矛盾的未来工作，在以康复为重点的痴呆症护理中可能至关重要。
