The impact of dementia and mild memory impairment (MMI) on intimacy and sexuality in spousal relationship: Summary and critique of the article

Summary of the article

Davies et al (2010) belief that there is still an absence of studies that investigate the issue of sexuality and intimacy which are affected by cognitive and memory impairment occurring on married couples. Previous studies have only touched the surface of the issue and have not generated clear insights and directions to create better outcomes. Thus, between 2008 and 2009 they conducted a research which is aimed to investigate the issues of intimacy and sexuality experienced by the spousal caregivers of people with dementia and MMI and to determine other aspects that may need to be investigated within this population through
further research.

A focus group discussion is applied as the methodology of this qualitative research. The authors argue that although this method may have limitations it is still the adequate method that also has been widely used in other research that focusing on the area of sexual health.  The participants of the research are spousal caregivers of people with dementia (n = 14) and MMI (n = 9) which are then grouped to two groups of each. The group discussion is moderated by one of the authors who have the expertise in adult psychiatric mental health using prompt questions. In the discussions, two observers are responsible in transcribing the group sessions. Their transcriptions are then reviewed against each other to identify bias and to ensure the content accuracy. The authors acknowledge that the procedures of the research are approved by the Stanford University Committee on Human Research and the Palo Alto Veterans Affairs Medical Center Research and Development Committee.

Two phases of analysis are done in the research. Modified indexing guidelines from Frankland and Bloor (1999) is applied to analyse the themes and create final categories. Then, a grid technique is done to compare and contrast the themes from the discussions. Five themes that emerged as the results are; communication, marital cohesion, affectional expression, caregiver burden and ambiguity concerning the future relationship. Overall, the report describes that the dementia caregivers groups experienced more problems and difficulties than the MMI. Both groups experienced a decrease in sexual expressions and have difficulties in anticipating the future of their relationship. The results also describe that the dementia caregivers have the desire to have future romantic relationship, whereas, the MMI caregiver only consider having companions or engage in emotional intimacy with other people. Thus, the research suggests that modifications in activities, behaviour and expectations about the future relationship are required as early intervention to maintain the relationship and avoid negative impacts for families and healthcare system.

Critique

Davies et al (2010) has conducted a research on the area that is challenging and has obtained a result that is very useful for further researcher on the area of sexuality and intimacy on people with cognitive impairment and their caregivers. The suggestions it offers in overcoming or reducing the sexuality and intimacy problems experienced by caregivers of people with dementia or MMI are excellent and applicable.  The research article is well presented and succinct, thus, it facilitates readers to comprehend the content of the article very well.  Furthermore, it is published in International Psychogeriatrics, which is acknowledged as ‘a highly respected, multidisciplinary journal’ and ’publishes high quality original research papers in the field of psychogeriatrics’ (Cambridge Journals Online 2011).

However, there are some weaknesses of the research and the report that are apparent from the article. The authors have included the caregivers of people with mild cognitive impairment as participants of the research and grouped them in the MMI. Although both conditions indicate ‘prodormal forms of dementia’ (Petersen et al 2001, Petersen 2005, Ishikawa et al 2006, cited in Davies et al 2010, p. 618), they are slightly different in manifestations (Dawe et al 1992, Peterson et al 1999). Furthermore, the result of the research has low level of external validity, because the number and characteristics of the participants are limited and homogenous (Davies et al 2010, p. 625). Thus, it cannot be generalized and applied to the wider population (Elwood 1998, cited in Evans 2003, p. 80).

Biases that occur in the research and affected the result of the study can be due to the characteristics of the participants. As an instant, the fact that caregivers in the dementia group have higher mean in the length of relationship and duration of the time after they received the diagnosis to the discussion, 44 years and 2 years, respectively, can affected the breadth and depth of the live experience of these caregivers (O’Shaughnessy et al 2010). Thus, it can already be predicted that they have experienced more difficulties on the issue of sexuality and intimacy compared to their counterparts. Furthermore, the frequent use of words that cannot be exactly measured in the report such as ‘almost universally’ (Davies et al 2010, p. 623) is leading readers to confusion due to uncertainty of information.

Nevertheless, the article is very useful for health professionals in supporting caregivers of people with dementia or MMI to achieve a high quality of life and preserve their relationships with their spouses. Particularly for nurses, the research triggers them to facilitate couples that are affected with cognitive impairments such as dementia, MMI and MCI to modify their daily activities in preserving their relationships. Thus, ageing in place (Australian Government, Department of health and Ageing, 2004) can be implemented and financial burden can be reduced both for the health care system and the family (Davies et al 2010).

Conclusion

The research conducted by Davies et al (2010) which is reported as an article and published in a respected journal is noteworthy. The methodology is consistent with the research approach and it briefly describes five themes that emerged as the results. Although there are several limitations, the research generates excellent suggestions that may help health professionals to facilitate spousal caregivers of people with dementia, MMI and MCI in overcoming the issues of intimacy and sexuality in their relationship.

References

Ageing in Place Policy 2004, Australian Government. Department of Health and Ageing. Viewed 28 March  2011,
<http://www.health.gov.au/internet/main/publishing.nsf/Content/health-investinginagedcare-report-index.htm~health-investinginagedcare-report-2.htm~health-investinginagedcare-report-2-3.htm&gt;.

Dawe, B, Procter, A & Philpot, M 1992, ‘Concepts of mild memory impairment in the elderly and their relationship to dementia: A review’, International Journal Of Geriatric Psychiatry, vol. 7, pp. 473-479.

Davies, H, Newkirk, L, Pitts, C, Coughlin, C, Sridhar, S, Zeiss, L & Zeiss, A 2010, ‘The impact of dementia and mild memory impairment (MMI) on intimacy and sexuality in spousal relationship’, International Psychogeriatric, vol. 22, no. 4, pp. 618 628.

Evans, D 2003, ‘Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions’, Journal of Clinical Nursing,  vol. 12, pp. 77–84.

International Psychogeriatrics 2011, Cambridge Journals Online, viewed 4 April 2011, <http://journals.cambridge.org/action/displayJournal?jid=IPG&gt;.

O’Shaugnessy, M, Lee, K & Lintern, C 2010, ‘Changes in the couple relationship in dementia care: Spouse carers’ experiences’, Dementia, vol. 9, pp. 237-259.

Petersen, R, Smith, G, Waring, S, Ivnik R, Tangalos, E & Kokmen, E 1999, ‘Mild cognitive impairment: Clinical characterization and outcome’, Arch Neurol, vol. 56, pp. 303-308.

Steeman, E, Godderis, J, Grypdonck, M, De Bal, N & De Casterle, B, 2007, ‘Living with dementia from the perspective of older people: Is it a positive story?’, Aging & Mental Health, vol. 11, no. 2, pp. 119-130.

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