Walking in the neighbourhood: Performing social citizenship in dementia.

The proliferation of community-based activity programs for people with dementia suggests an appetite for new approaches to support quality of life and well-being for this population. Such groups also have potential to promote social citizenship, although this remains poorly understood. This article presents findings from a subset of data from an ethnographic study of a community-based program for people with young onset dementia; it focuses on Paul's Club and the experiences of 12-15 members who are physically healthy, with moderate to moderately severe dementia. Analysis suggests how aspects of social citizenship are constructed and revealed through the Club's everyday practice of walking in the neighbourhood. Three major themes emerged: Keeping the focus off dementia; Creating a place of belonging; and Claiming a place in the community How the group balances consideration of members' vulnerability and agency is discussed, and the article concludes with implications for future practice and research initiatives.

"You Can Lead a Horse to Water ": Focus Group Perspectives on Initiating and Supporting Hearing Health Change in Older Adults.

PURPOSE: The aim of this study was to use focus group discussions to (a) evaluate the use of an educational presentation as an impetus for hearing health change and (b) investigate hearing health from the perspective of older adults. METHOD: Twenty-seven (4 men, 23 women) community-dwelling older adults attended 4 data collection events. Participants attended a presentation titled Hearing Health in Older Adults, which was delivered by a trained presenter in a peer-teaching-peer format. Following each presentation, a focus group discussion took place. Digital audio recordings, field notes, and memos of the discussions were used to create verbatim transcripts. Data were analyzed using qualitative description and thematic analysis techniques. RESULTS: Five central themes emerged when older adult focus groups discussed the presentation and hearing health change: recognizing and admitting, understanding the options, sharing stories and experiences, barriers and facilitators, and the presentation. CONCLUSION: Facilitators to hearing health change identified by participants include widespread education about hearing health; clarification about roles, professional motivation, and cost in hearing care; and opportunities to learn from and share personal stories with peers.

Developing CIRCA-BC and exploring the role of the computer as a third participant in conversation.

The Computer Interactive Reminiscence Conversation Aid (CIRCA) is a software program using touch screen technology and digital materials from public archives to support conversation between people with dementia and their carers. In this 2-phase study, we first worked with seniors' focus groups to identify and select relevant content for a regional adaptation of CIRCA (British Columbia version of CIRCA [CIRCA-BC]). We then pilot tested CIRCA-BC with 3 participants having dementia and a conversation partner, analyzing their interactions to explore how they drew on program content and format to shape their conversations together. Findings provide insight into, first, how participants' shared and distinct social histories influence reminiscence-based conversations and, second, how the computer can be viewed as a third "participant" in the interaction. These findings offer guidelines for ongoing adaptation and application of the CIRCA program in addition to contributing further evidence regarding the role of technology in facilitating meaningful interaction between people with dementia and their carers.

Cochlear implantation for a child with cochlear nerve deficiency: parental perspectives explored through narrative.

OBJECTIVE: The objective of this study was to explore, from the parents' perspectives, decision-making regarding a cochlear implant (CI) for their child when a favourable outcome is less likely because of abnormal neurophysiology. DESIGN: The primary research method of this single case study was qualitative interviewing drawing on a narrative approach to elicit the parents' perspectives about their experiences over time. Each parent was interviewed separately, but thematic analyses were undertaken both within and across interviews in order to identify overlaps and differences. STUDY SAMPLE: Participants included the parents of a five-year old child with severe-profound hearing loss, cochlear nerve deficiency, and bilateral common cavities who had received a CI at the age of 18 months. RESULTS: Four themes were identified across the four narrative stages that emerged from the parents' accounts of their experiences regarding their daughter's CI. Themes included hope and despair, questioning professionals' motivations, does deafness need a cure, and bringing the child into the family. Although these themes emerged from both parents' accounts, each parent expressed different perspectives and insights within them. CONCLUSIONS: Findings highlight the central place of parental needs and perspectives in decision-making regarding a CI, particularly in the context of uncertain outcomes.

An aphasia mentoring program: perspectives of speech-language pathology students and of mentors with aphasia.

PURPOSE: In contrast to clinician-as-expert models, social models of clinical practice typically acknowledge people with aphasia as equal partners in intervention. Given this, there may be a place within speech-language pathology education for programs situating people with aphasia as experts. This paper describes an aphasia mentoring program that was implemented as part of a speech-language pathology graduate program. METHOD: Qualitative research methods with thematic analysis of interviews, focus groups, questionnaires, and participant observation were used to develop a description of the mentoring program, including the experiences and perspectives of the participants-both mentors (people with chronic aphasia) and students. RESULTS: Five themes, including getting better, aphasia advocacy, group as versus for therapy, we're a team, and focus on mentoring, emerged from the mentors' data. Five themes, including shifting the power dynamic, getting to know the person, seeing members as mentors, making classroom learning real, and connecting with a community, emerged from the students' data. There were significant overlaps and intersections between the 2 data sets. CONCLUSION: Findings revealed how an aphasia mentoring program that positions people with aphasia as experts can make a significant contribution to student education while supporting mentors' own goals, with implications for improved quality of life.

Shifting patterns of everyday activity in early dementia: experiences of men and their families.

In this article we draw from a larger study to examine experiences of two men and their families as they negotiate changing patterns of everyday activity in the months after receiving a diagnosis of dementia. We conducted in-depth interpretive phenomenological analysis of interview and observational data that were gathered from the men and various members of their families (n = 7) over a period several months. Findings are presented as three themes: The best kind of man (highlighting participants' historical positioning); It's a little different now (recognizing challenges posed by the dementia); and You have to do something (showing how the men and their families responded to and accommodated these challenges). We discuss these findings in terms of how everyday activity is not only important for supporting personhood in dementia, but it also contributes to sustaining family identity, and does so in a way that is deeply influenced by gender and masculinity.

In limbo: creating continuity of identity in a discharge planning unit.

BACKGROUND: Patients in hospital discharge planning units are often described as waiting for placement, implying a passivity that is not necessarily part of their experience. The anthropological concept of liminality, which refers to both a state of being and a process during which people are suspended between former and future selves, offers a framework for exploring patients'experiences of a discharge planning unit as a transitional space. METHODS: This pilot qualitative study incorporates participant observation and ethnographic interviewing to explore how two patients living in the discharge planning unit of a large urban hospital use weekly bus trips into the community to actively renegotiate their sense of self. RESULTS: An interpretation of the findings using the concepts of emplotment and occupation reveals how patients in a liminal environment work to create meanings through disruptions in their lives. PRACTICE IMPLICATIONS: The renegotiation of identity through occupations highlights the transformative potential of these experiences, suggesting possibilities for occupational therapists to support their clients in that process of change.