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EXPLORING EVERYDAY ACTIVITIES IN RELATION TO COGNITION AND WELL-BEING IN DEMENTIA: IMPLICATIONS FOR CARE INTERVENTIONS
[Thesis]. Manchester, UK: The University of Manchester; 2018.
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Abstract
This thesis, entitled 'Exploring everyday activities in relation to cognition and well-being in dementia: Implications for care interventions', is being re-submitted by the doctoral candidate Clarissa Marie Giebel for the degree of a PhD in Psychology at the University of Manchester, on June 8th, 2018. People with dementia (PwD) experience difficulties with cognition and instrumental and basic activities of daily living (IADLs/ADLs). Although both can have a detrimental impact on the PwD' and the informal caregivers' well-being, little evidence has explored the degree of everyday activity impairments in mild dementia and its relationship to cognition. Therefore, this thesis aimed to: (1) start preliminary development of a questionnaire examining everyday activity deficits that incorporates new areas of activities breaks these down into sub-tasks; (2) assess the relationship between everyday activity and cognitive function in mild dementia and (3) assess the relationship between everyday activity and PwD and caregiver well-being; and (4) to synthesise the findings to begin to explore opportunities for everyday activity interventions in mild dementia. A mix of quantitative and qualitative methodologies were employed, involving questionnaire design, a cross-sectional postal survey, exploratory study design, narrative reviews, focus groups, and semi-structured interviews. Quantitative data were analysed using primarily correlation and regression analysis, and qualitative data were analysed using thematic analysis. Review 1 highlighted a gap in the evidence on detailed IADL/ADL impairments in mild dementia and their cognitive underpinnings. No theoretical approach has so far captured these relationships, so the first step towards the creation of a theoretically-driven model was conceptualised. Exploring individual IADL deficits led to the development of the Revised Interview for Deteriorations in Daily Living Activities in Dementia 2, which highlighted variations in the initiative and performance of everyday activities (Study A, B, and C). Specifically, Alzheimer's disease showed fewer impairments than vascular or mixed dementia. Study B and C showed that nearly all activities were significantly associated with PwD and caregiver well-being. Examination of individual ADLs (Study D) indicated their different deterioration throughout dementia, whilst ADL performance was only in some instances significantly associated with quality of life across Europe. Study E showed different cognitive underpinnings for the initiative and performance of IADLs, such as medication management being associated with attention and executive function. Review 2 showed that little to no theoretical knowledge had been amalgamated into everyday functioning interventions for mild dementia and mild cognitive impairment. The Synthesis coalesced all findings into the meaningful development of future interventions, guided by a two-stage focus group with health professionals and informal caregivers. In conclusion, this thesis successfully achieved its four stated aims by collating novel insights and providing a step forward, particularly through the Synthesis. Future research needs to explore the relationship between cognition and everyday functioning further, and integrate these new insights into non-pharmacological interventions, whilst the newly developed questionnaire also requires additional psychometric testing.