van Dijkhuizen, Mike; (2003) Appraisal and coping processes in women with early-stage Alzheimer's disease. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Psychological research has often ignored the self-reported experience of people with Alzheimer's disease. Their personal narrative of what is happening to them has often been overlooked on the assumption that cognitive impairment renders their account invalid. This qualitative study examined appraisal and coping processes in women with early-stage Alzheimer's disease. Semi-structured interviews were conducted with nine women. The partners or carers of the women were interviewed separately. The interviews were audio-taped, transcribed and analysed using Interpretative Phenomenological Analysis. This generated eleven themes describing how the women understood and managed their difficulties. These are grouped into three higher-order themes of Connectedness, Protective Strategies and Acceptance. The women experienced memory problems as a threat to connectedness or sense of self, derived from attachment to family and friends, affiliation with social roles, familiarity with surroundings and a sense of continuity with the past. A Level of Connectedness Model of the appraisal and coping processes of women with early-stage Alzheimer's disease is presented, which shows a tension between disconnection and coping strategies that relied on maintaining a connection with others and the environment. This places coping in an interpersonal framework, where the ability of the women to maintain a sense of self is inherently dependent on the readiness of others to facilitate connectedness. The results are discussed with reference to psychological theories, models of coping with chronic illness and previous qualitative research on coping with dementia, including a consideration of possible gender differences. The findings provide a useful focus for good clinical practice and psychosocial interventions that consider well-being in an interpersonal context.

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