Persistence of self in advanced Alzheimer's disease
RM Tappen, C Williams, S Fishman… - Image: The Journal of …, 1999 - Wiley Online Library
RM Tappen, C Williams, S Fishman, T Touhy
Image: The Journal of Nursing Scholarship, 1999•Wiley Online LibraryPurpose: To determine if evidence of the persistence of a sense of self or personal identity
could be found in people in the middle and late stages of Alzheimer's disease. The theme of
diminishing self pervades both the popular and professional literature on Alzheimer's
disease. Design: Qualitative using conversational analysis. The purposive sample was 23
residents of two urban nursing homes in the southeastern United States who were in the
middle and late stages of Alzheimer's disease. Their mean Mini‐Mental State examination …
could be found in people in the middle and late stages of Alzheimer's disease. The theme of
diminishing self pervades both the popular and professional literature on Alzheimer's
disease. Design: Qualitative using conversational analysis. The purposive sample was 23
residents of two urban nursing homes in the southeastern United States who were in the
middle and late stages of Alzheimer's disease. Their mean Mini‐Mental State examination …
Purpose
To determine if evidence of the persistence of a sense of self or personal identity could be found in people in the middle and late stages of Alzheimer's disease. The theme of diminishing self pervades both the popular and professional literature on Alzheimer's disease.
Design
Qualitative using conversational analysis. The purposive sample was 23 residents of two urban nursing homes in the southeastern United States who were in the middle and late stages of Alzheimer's disease. Their mean Mini‐Mental State examination score was 10.65. Nineteen subjects were women, four were men in this 1993‐1997 study.
Methods
Analysis of 45 conversations lasting 30 minutes with nursing home residents with a diagnosis of probable Alzheimer's disease. Use of the first person indexical and other evidence, such as awareness and reactions to the changes that had taken place, in support of and counter to the notion of persistence of self, were sought in conversational analysis.
Findings
Respondents used the first person indexical frequently, freely, and coherently. Evidence was also present that participants were aware of their cognitive changes. Many struggled to provide an explanation, but none mentioned Alzheimer's disease.
Conclusions
Evidence suggests the persistence of awareness of self into the middle and late stages of Alzheimer's disease. Failure to recognize the continuing awareness of self and the human experience of the person in the middle and late stages can lead to task‐oriented care and low expectations for therapeutic interventions. The bafflement noted in respondents suggests that people should be told their diagnosis and offered an explanation of what this diagnosis means.
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