They are still the same – family members’ stories about their relatives with dementia disorders as residents in a nursing home

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According to WHO and the Alzheimer′s Disease International 1, approximately 36 million people are diagnosed with dementia disorders (DD) and the number is expected to double every 20 years, with the greatest increase in the developing countries 3. According to the National Institute of Neurological Disorders and Stroke 4, dementia is not one disease but a number of disorders affecting different parts of the brain. Persons with DD have considerably reduced intellectual function, which in time will interfere with normal life, social activities and relationships. Most will experience lack of or reduced memory and capacity to resolve problems in daily life. Some will lose their emotional control, experience a changed personality and ability to interact with other people due to behavioural problems. The DD include; Alzheimer's disease (AD), vascular dementia, Lewy body dementia, frontotemporal dementia, Huntington's disease, and Creutzfeldt–Jakob disease. The prognosis of DD varies depending on disease; AD and Huntington's disease, cause extensive loss of cognitive functions, often with needs of constant care, supervision, and assistance with daily life activities, while others such as vascular dementia may even be halted with correct medical treatment.
Most persons with DD are initially cared for at home by their family members 5. This is in line with the national policy act in Sweden 6. However, as the disorder progresses and the ability to stay at home decreases 7, the need for assistance and support from social services increase far beyond that of age matched non‐demented elderly 8. It is therefore suggested that elderly with DD are more likely to move to nursing homes at an earlier age than persons without 10. In Sweden continuity of care as well as personal autonomy are core values in the social welfare system. To promote this a new law 2 and a national care reform were implemented in some municipalities with the purpose of making it possible to freely choose among nursing homes when such residential care was judged necessary.
Pesonen et al., 11 proposed that as a person is diagnosed with DD it will affect the whole family, influencing social interactions, identity and roles within the family. According to Meleis, et al., 12 changes in health and illness create a process of transition. A person in transition has a tendency to be more susceptible to risks that may affect their health. To discover these risks, understanding of the process of transition is necessary. Transition is described as a concept consisting of various types and patterns, facilitating and/or inhibiting situations, properties of experiences, personal identity, process indicators and outcome indicators and nursing therapeutics. As the health status changes, it may provide opportunities for improved well‐being but also to reveal increased risks of illness and ill‐being. Meleis et al. 12 further explored the concept of vulnerability as it may be understood from the persons own experiences and responses during times of transition. Therefore, vulnerability is connected to experiences, interactions, and environmental conditions exposing the person to possible damage, challenged or prolonged recovery and/or hindrance or unhealthy managing of illness. A person's daily life is affected by the environment one is living in; conditions, meanings, and processes of experiences of transitions. In that sense transitions are a result of and result in changes in a person's life, health, relationships, and environments. Health transitions occurring in ill persons may affect all family members as their roles and identities’ within the family could also affect their relationships 13.
When new patterns of interdependence between family members occur, Livingston et al. 14 suggest that a shift in power balance takes place.

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