Abstract
The overarching aim of this study was to extend and deepen the understanding of the consequences and experiences of dementia in everyday life. The first study (I) compared the performances of the instrumental activities of daily life (IADL) in an unfamiliar, clinical setting and in the familiar home settings of 19 subjects with suspected dementia. The Assessment of Motor and Process Skills (AMPS) was used for observing IADL performance. The results showed no overall difference between the settings for the group of subjects, while statistically significant differences were exhibited for individual subjects.
In Study Il, the relationships between the AMPS IADL motor and process abilities, and the cognitive functions, as assessed by 14 neuropsychological tests, were investigated among 52 subjects with mild Alzheimer's disease. Significant predictors of AMPS IADL ability were psychomotor speed, flexibility, visuoconstructive function and secondary memory. The cognitive tests explained 24-26% of the variation in AMPSIADL abilities.
In Study III, the consequences of dementia in the everyday lives of two early-onset participants were explored. The everyday occupational difficulties of the participants and their individually divergent strategies for compensation that were exhibited in the data were described. The difficulties and the compensational efforts of the two participants seemed to bring about very different consequences for the two participants' everyday living.
To understand this difference, further investigations were conducted in Study IV, and the participants' strategies for managing their images of the occupational self by attributing the disease and its consequences to their ability were discovered and interpreted.
In Study V, the participants' experiences of living with the illness in everyday life during three years were explored by a phenomenological approach, which resulted in a phenomenological structure. This structure revealed an altering meaning of the life-world and a perceived threat to order and control that was met and resisted in individually different ways. In summary, the results exhibited considerable consequences in everyday life from a dementing disease for the afflicted persons, and highly individualised meanings, management strategies and experiences of the changes brought about by the disease. The environment's impact seemed to be too complex to be captured by assessments of IADL ability in relation to familiarity only. The importance of a meaning-searching and individualised perspective in therapy and caregiving was discussed and emphasised.
