Symptoms such as amnesia, agnosia, apraxia, and aphasia may lead to a fragmented experience and actions among people with moderate and severe dementia. The aim of this study was to explore the interactions where fragmentation occurred and how caregivers counteract fragmentation. The observation notes from participant observations were analyzed using interpretive content analysis. Fragmentation was noted if the patients showed that they did not recognize what was going on, the people involved, the things used in the action, or did not recognize themselves in the situation. Care providers could counteract fragmentation by a caring based on attentive interest in the interaction, valuing the person behind the dementia disease, using an individual perspective considering the impact of the dementia disease, and striving for mutual interpretation of the shared situation. Caring based on these assumptions could help the patients to keep their world together.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders(4th ed.). Washington, DC: Author.
2.
Asplund, K., Norberg, A., & Adolfsson, R. (1991). The sucking behaviour of two patients in the final stage of dementia of the Alzheimer type. Scandinavian Journal of Caring Sciences, 5, 141-147.
3.
Athlin, E., Norberg, A., & Asplund, K. (1990). Caregivers' perceptions and interpretations of severely demented patients during feeding in a task assignment care system. Scandinavian Journal of Caring Sciences, 4(4), 147-155.
4.
Baxter, L. A. (1994). Content analysis. In B. M. Montgomery & S. Duck (Eds.), Studying interpersonal interaction(pp. 239-254). New York: Guilford.
5.
Berg, A., Hallberg, I. R., & Norberg, A. (1998). Nurses' reflections about dementia care, the patients, the care and themselves in their daily caregiving. International Journal of Nursing Studies, 35, 271-282.
6.
Edberg, A.-K., Hallberg, I. R., & Gustafson, L. (1996). Effects of clinical supervision on nurse-patient cooperation quality: A controlled study of dementia care. Clinical Nursing Research, 5, 127-149.
7.
Ekman, S.-L., & Norberg, A. (1993). Characteristics of the good relationship in the care of demented bilingual immigrants. In S.-L. Ekman (Ed.), Monolingual and bilingual communication between patients with dementia diseases and their caregivers(Medical Dissertations, New Series No. 370, pp. 139-156). Umeå, Sweden: Umeå University.
8.
Ekman, S.-L., Norberg, A., Robins Wahlin, T.-B., & Winblad, B. (1995). Dimensions and progression in the interaction between bilingual/monolingual caregivers and bilingual demented immigrants: Analysis of video-recorded morning care sessions in institutions coded by means of the Erikson theory of “eight stages of manInternational Journal of Aging and Human Development, 41, 29-45.
9.
Ekman, S.-L., Wahlin, T.-B., Norberg, A., & Winblad, B. (1993). Relationship between bilingual demented immigrants and bilingual/monolingual caregivers. International Journal of Aging and Human Development, 37, 37-54.
10.
Fick, D. M., Agostini, J. V., & Inouye, S. K. (2002). Delirium superimposed on dementia: A systematic review. Journal of the American Geriatrics Society, 50, 1723-1732.
11.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.
12.
Ghali, L., Hopkins, R. W., & Rindlisbacher, P. (1995). The fragmentation of rest/activity cycles in Alzheimer's disease. International Journal of Geriatric Psychiatry, 10, 299-304.
13.
Götell, E., Brown. S., & Ekman, S.-L. (2002). Caregiver singing and background music in dementia care. Western Journal of Nursing Research, 24, 195-216.
14.
Graneheim, U. H., Norberg, A., & Jansson, L. (2001). Interaction relating to privacy, identity, autonomy and security. An observational study on a woman with dementia and “behavioral disturbances,” and on her care providers. Journal of Advanced Nursing, 36, 256-265.
15.
Hadjistavropoulos, T., & Craig, K. D. (2002). A theoretical framework for understanding self-report and observational measures of pain: A communications model. Behavior Research and Therapy, 40, 551-570.
16.
Häggström, T., Jansson, L., & Norberg, A. (1998). Skilled carers' ways of understanding people with Alzheimer's disease... including commentary by Collins C. Scholarly Inquiry for Nursing Practice, 12, 239-268.
17.
Hallberg, I. R., Holst, G., Nordmark, Å., & Edberg, A. K. (1995). Cooperation during morning care between nurses and severely demented institutionalized patients. Clinical Nursing Research, 4, 78-104.
18.
Hansebo, G., & Kihlgren, M. (2002). Carers' interactions with patients suffering from severe dementia: A difficult balance to facilitate mutual togetherness. Journal of Clinical Nursing, 11, 225-236.
19.
Harrison, C. (1993). Personhood, dementia and the integrity of life. Canadian Journal on Aging, 12, 428-440.
20.
Insel, K. C., & Badger, T. A. (2002). Deciphering the 4 D's: Cognitive decline, delirium, depression and dementia—A review. Journal of Advanced Nursing, 38, 360-368.
21.
Jansson, L., Norberg, A., Sandman, P. O., Athlin, E., & Asplund, K. (1993). Interpreting facial expressions in patients in the terminal stage of the Alzheimer disease. Omega, 26, 309-324.
22.
Jenkins, D., & Price, B. (1996). Dementia and personhood: A focus for care?Journal of Advanced Nursing, 24, 84-90.
23.
Kihlgren, M., Hallgren, A., Norberg, A., & Karlsson, I. (1994). Integrity promoting care of demented patients: Patterns of interaction during morning care. International Journal of Aging and Human Development, 39, 303-319.
24.
Kihlgren, M., Hallgren, A., Norberg, A., & Karlsson, I. (1996). Disclosure of basic strengths and basic weaknesses in demented patients during morning care, before and after staff training: Analysis of video-recordings by means of the Erikson theory of “eight stages of man. International Journal of Aging and Human Development, 43, 219-233.
25.
Kihlgren, M., & Thorsén, H. (1998). Long-term care staff's view, over time, of patient's integrity. European Nurse, 3, 254-263.
26.
Laing, R. D. (1967). The politics of experience. Harmondsworth, UK: Penguin Books.
27.
Lawton, M. P. (1983). Environment and other determinants of well-being in older people. The Gerontologist, 23, 349-357.
28.
Logsdon, R. G. (2002). Making the most of every day: Quality of life in Alzheimer's disease. In P. B. Harris (Ed.), The person with Alzheimer's disease: Pathways to understanding the experience(pp. 75-87). Baltimore, London: Johns Hopkins University Press.
29.
Milchrist, P. A. (2001). Alzheimer's: Cultivating optimal levels of flow through dance. Journal of Aging and Physical Activity, 9, 265-268.
30.
Molloy, D. W., Alemayehu, E., & Roberts, R. (1991). Reliability of a Standardized Mini-Mental State Examination compared with the traditional Mini-Mental State Examination. American Journal of Psychiatry, 148, 102-105.
31.
Norberg, A. (1996). Perspectives of an institution-based research nurse. International Psychogeriatrics, 8, 459-463.
32.
Norberg, A., Sandman, P.-O., & Winblad, B. (1985). Etiska överväganden vid forskning på dementa patienter [Ethical considerations in connection with research on patients with dementia]. Läkartidningen, 82, 4528-4530.
33.
Normann, H. K., Asplund, K., & Norberg, A. (1998). Episodes of lucidity in people with severe dementia as narrated by formal carers. Journal of Advanced Nursing, 28, 1295-1300.
34.
Normann, H. K., Asplund, K., & Norberg, A. (2002). Confirmation and lucidity during conversations with a woman with severe dementia. Journal of Advanced Nursing, 39, 370-376.
35.
Palo-Bengtsson, L., & Ekman, S.-L. (1997). Social dancing in the care of persons with dementia in a nursing home setting: A phenomenological study. Scholarly Inquiry for Nursing Practice: An International Journal, 11, 101-118.
36.
Polit, D. F., & Hungler, B. P. (1995). Nursing research; Principles and methods. Philadelphia: Lippincott.
37.
Roberto, K. A., Richter, J. M., Bottenberg, D. J., & Campbell, S. (1998). Communication patterns between caregivers and their spouses with Alzheimer's disease: A case study. Archives of Psychiatric Nursing, 12, 202-208.
38.
Skovdahl, K., Kihlgren, A. L., & Kihlgren, M. (2004). Dementia and aggressiveness: Stimulated recall interviews with caregivers after video-recorded interactions. Journal of Clinical Nursing, 13, 515-525.
39.
Tappen, R. M., Williams, C., Fishman, S., & Touhy, T. (1999). Clinical scholarship. Persistence of self in advanced Alzheimer's disease. Image: Journal of Nursing Scholarship, 31, 121-125.
40.
Vittoria, A. K. (1998). Preserving selves, identity work and dementia. Research on Aging, 20, 91-136.
41.
Zingmark, K., & Norberg, A. (2000). Moments of homecoming: A case study about a woman with Alzheimer's disease. In K. Zingmark (Ed.), Experience related to home in people with Alzheimer's disease(Medical Dissertations, New Series No. 700, pp. 119-133). Umeå, Sweden: Umeå University.
