Are the barriers to good oral hygiene in nursing homes within the nurses or the patients?

doi: 10.1111/j.1741‐2358.2011.00554.x
Are the barriers to good oral hygiene in nursing homes within the nurses or the patients? Objective: To explore nursing home patients’ oral hygiene and their nurses’ assessments of barriers to improvement. Background: In nursing homes, nurses are responsible for patients’ oral hygiene. Materials and methods: This study assessed the oral hygiene of 358 patients in 11 Norwegian nursing homes. 494 nurses in the same nursing homes participated in a questionnaire study. Results: More than 40% of patients had unacceptable oral hygiene. ‘More than 10 teeth’ gave OR = 2, 1 (p = 0.013) and ‘resist being helped’ OR = 2.5 (p = 0.018) for unacceptable oral hygiene. Eighty percent of the nurses believed knowledge of oral health was important, and 9.1% often considered taking care of patients’ teeth unpleasant. Half of the nurses reported lack of time to give regular oral care, and 97% experienced resistant behaviour in patients. Resistant behaviour often left oral care undone. Twenty‐one percent of the nurses had considered making legal decisions about use of force or restraints to overcome resistance to teeth cleaning. Conclusion: Oral hygiene in the nursing homes needed to be improved. Resistant behaviour is a major barrier. To overcome this barrier nurses’ education, organisational strategies to provide more time for oral care, and coping with resistant behaviour in patients are important factors.     

Understanding the ‘epidemic’ of complete tooth loss among older New Zealanders

doi:10.1111/j.1741‐2358.2009.00306.x
Understanding the ‘epidemic’ of complete tooth loss among older New Zealanders Objective: The aim of this study was to obtain a deeper understanding of the social factors driving New Zealand’s historic ‘epidemic of edentulism’ and how they operated. Method: In‐depth, semi‐structured interviews with 31 older New Zealanders were analysed using applied grounded theory. Results: Universal factors present in the data were: (a) the way in which New Zealand society accepted and indeed encouraged edentulism without stigma for those who had a ‘sub‐optimal’ natural dentition; (b) how the predominant patterns of dental care utilisation (symptomatic and extraction‐based) were often strongly influenced by economic and social disadvantage; and (c) the way in which lay and professional worldviews relating to ‘calcium theory’ and dental caries were fundamental in decisions relating to the transition to edentulism. Major influences were rural isolation, the importance of professional authority and how patient‐initiated transitions to edentulism were ultimately facilitated by an accommodating profession. Conclusion: The combined effects of geography, economics, the dental care system and the professional culture of the day, in the context of contemporary (flawed) understandings of oral disease, appear to have been the key drivers. These were supported (in turn) by a widespread acceptance by the profession and society alike of the extraction/denture philosophy in dealing with oral disease.     

Validation of the use of phenylhydrazine hydrochloride (PHZ) for experimental manipulation of haematocrit and plasma haemoglobin in birds

The levels of haematocrit (Hct) and plasma haemoglobin (Hb) vary markedly through the annual cycle of birds, as well as among individuals at all life‐stages (embryos, chicks, adults). It is thus surprising that the functional, fitness‐related consequences of this variation are poorly understood. Putative ‘adaptive’ variation in these haematological traits has been associated with varying demands for aerobic capacity and oxygen transport, for example during migration, winter acclimatization, with increasing altitude, or during parental care. It has also been proposed that changes in Hct might reflect ‘costs’ of parental investment, for example during ‘reproductive anaemia’. However, almost all studies to date have been correlative. Here we describe a series of experiments that validate the use of phenylhydrazine hydrochloride (PHZ) for the transient, reversible experimental manipulation of Hct and Hb in birds. A single bolus injection (12.5 μg PHZ/g body weight delivered via intra‐muscular injection) caused a rapid decrease in Hct and plasma Hb within 24 h, from pretreatment values of 50–54% to 40–44% in non‐breeding Zebra Finches Taenipoygia guttata and European Starlings Sturnus vulgaris, and to 35% in breeding female Zebra Finches, changes within the normal physiological range. Hct and Hb returned to pre‐injection levels within 5–10 days of treatment. Changes in plasma Hb paralleled those for Hct. We suggest that PHZ treatment provides a widely applicable technique for use in experimental work to establish relationships between haematological status, aerobic capacity, workload (e.g. migration, parental care, thermoregulation), individual quality (of both adults and chicks) and trade‐offs such as costs of reproduction.     

Hatching and viability of rotifer diapausing eggs collected from pond sediments

1. Planktonic rotifers inhabiting variable environments produce diapausing eggs that accumulate in the sediment of lakes and ponds, forming egg banks that may withstand adverse periods. A common assumption in zooplankton diapausing egg bank studies is to count as viable all eggs in the sediment that look healthy. This assumption should be challenged by asking how effectively ‘healthy‐looking’ eggs represent viable eggs. 2. In this study, viability of more than 1100 ‘healthy‐looking’ diapausing eggs belonging to the Brachionus plicatilis species complex was assessed in a laboratory hatching experiment. Eggs were collected at different depths from sediment cores obtained from 15 ponds located in coastal and inland areas of Eastern Spain. 3. Only approximately one half of the ‘healthy‐looking’ diapausing eggs hatched after incubation in experimental conditions. Almost all the hatchlings (99.4%) survived to maturity. The proportion of ‘healthy‐looking’ diapausing eggs that hatched varied among areas and among ponds within area, and substantially declined with sediment depth. Most of the hatchlings (88%) were obtained from the uppermost 2 cm of sediment. ‘Healthy‐looking’ eggs from upper sediment layers hatched after significantly shorter incubation times than eggs recovered from deeper layers. 4. Both decreased hatching success and increased incubation time for hatching with sediment depth suggest that older ‘healthy‐looking’ eggs are less responsive to hatching stimuli and could become unviable. However, the strong correlation found between the number of ‘healthy‐looking’ eggs and the number of hatchlings indicates that the abundance of ‘healthy‐looking’ eggs is a good index of egg bank viability.     

Pollution and Intimacy in a Transcendent Ethics of Care: A Case of Aged-care in India

In India, where children’s care of ageing parents is seen as practical and sacred, animated by notions of seva (selfless service), the outsourcing of elder care causes considerable concern. Meanwhile, carers’ work in old-age homes is treated as transactional, and their moral claims about this work are either overlooked or criticised. While gendered, socio-economic circumstances compel the women we discuss in this paper to care-work at an old-age home in Pune, they also understood this work as a register for the spiritual striving normally reserved for higher classes and castes. Accordingly, notions of polluting and non-polluting bodily waste inform the sense of kin-like intimacy through which they frame their labour. Attending to the institutional, spiritual, emotional and bodily registers of these carers’ work, we argue for a transcendent ethics of care, a conceptualisation that contributes to broader understandings of marginalisation and moral imagination in an ordinary ethics of care.     

Artificial womb technology and clinical translation: Innovative treatment or medical research?

In 2017 and 2019, two research teams claimed ‘proof of principle’ for artificial womb technology (AWT). AWT has long been a subject of speculation in bioethical literature, with broad consensus that it is a welcome development. Despite this, little attention is afforded to more immediate ethical problems in the development of AWT, particularly as an alternative to neonatal intensive care. To start this conversation, I consider whether experimental AWT is innovative treatment or medical research. The research–treatment distinction, pervasive in regulation worldwide, is intended to isolate research activities and subject them to a greater degree of oversight. I argue that there is a tendency in the literature to conceptualize AWT for partial ectogenesis as innovative treatment. However, there are sufficiently serious ethical concerns with experimental AWT that mean that it must not be first used on humans on the basis that it is a ‘beneficial treatment’. First, I outline the prospects for translation of AWT animal studies into treatment for human preterms. Second, I challenge the conceptualizations of experimental AWT as innovative treatment. It must be considered medical research to reflect the investigatory nature of the process and guarantee sufficient protections for subjects. Identifying that AWT is research is crucial in formulating further ethico-legal questions regarding the experimental use of AWT. Third, I demonstrate that clinical trials will be a necessary part of the clinical translation of AWT because of requirements laid out by regulators. I consider the justification for clinical trials and highlight some of the crucial ethical questions about the conditions under which they should proceed.     

Linking elements in German Origin, Change, Functionalization

Contemporary German is known for its complex system of linking elements. They not only show different degrees of productivity (between unproductive -es- and very productive -s-), but also exhibit functional diversity, with some of them even allowing plural interpretation, e.g. -er- in Völk+er+kunde ‘ethnology’ vs. Volk+s+kunde ‘folklore’. In this paper, we argue that this is due to the complex historical development from two different sources. The first layer of linking elements, which arose out of Germanic primary suffixes, was reduced to one member, the “older” linking -e-, already in Old High German (e.g. in NHG Tag+e+werk ‘daily task’). The current functional diversity of the linking elements is primarily due to the later evolution out of inflectional endings. The dissociation from the second source has included a gradual change of the assignment rules from lexical (gender, declension class) to prosodic (formal) level. Thus, the current distribution of the most developed linking -s- is the most formalized one, as it can be directly deduced from the prosodic form of the first constituent. The development of the second layer of linking elements resembles the process of grammaticalization. However, linking elements form part of word formation and therefore are not the typical result of grammaticalization.     

Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders

doi: 10.1111/j.1741‐2358.2010.00402.x Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders Background: Most research on older people’s oral health has been quantitative. A need for more in‐depth understanding of the oral health of that age group has pointed to a need for more qualitative investigations. Objective: To explore experiences and perceptions of oral health and oral health care among an ethnically‐mixed sample of older New Zealanders. Methods: In‐depth interviews were conducted with 24 older people in two communities in New Zealand’s South Island. Thematic analysis of transcribed data was undertaken. Results: Three main themes that emerged were: (1) the processes of negotiating a tension between cost and convenience of access; (2) the experiential constraining of oral health maintenance; and (3) trusting in dental professionals. These serve to organise processes such as normalising, justifying and social comparisons that create an equilibrium or tolerance and acceptance of what might otherwise be considered to be relatively poor oral health. Conclusions: We identified a number of shared experiences which affect older people’s ability to maintain their oral health in the face of material and social barriers to oral health care. Because expectations were generally lower, there was greater concordance between experience and expectation, and people tended to be fairly satisfied with their oral health and the care they had received.     

Weiqu,structural injustice and caring for sick older people in rural Chinese families: An empirical ethical study

This paper examines caregiving for sick older family members in the context of socio-economic transformations in rural China, combining empirical investigation with normative inquiry. The empirical part of this paper is based on a case study, taken from fieldwork in a rural Chinese hospital, of a son who took care of his hospitalized mother. This empirical study highlighted family members’ weiqu (sense of unfairness)—a mental status from experiencing mistreatment and oppression in family care, yet with constrained power to explicitly protest or make care-related choices. Underpinning people’s weiqu and constrained choice, as informed by the conception of structural injustice, is the impact of unjust social structures, organized by unfavourable norms, discriminatory social policies and institutions targeting rural populations. By restraining individual choices and capacities in supporting health care for aging populations, these unjust structures create additional difficulties for and discriminations against rural families and their older members. Some policy recommendations are proposed to mitigate structural injustice so as to empower families and promote care for older people in rural settings.     

A comparative perspective on the evolution of tamarin and marmoset social systems

Tamarins and marmosets (callitrichids) present an unusual opportunity for study of the determinants of primate social systems, because both the mating and infant care patterns of callitrichids are variable, even within individual populations. In this paper, I briefly describe three characteristics of callitrichid social systems that distinguish them from most other primates: extensive male parental care, helping by nonreproductive individuals, and variable mating patterns. I then discuss the evolution of these characteristics and of the frequent twinning exhibited by callitrichids. I suggest that an ancestor of modern callitrichids gave birth to a single offspring at a time, mated monogamously, and had significant paternal care. The idea that males of this ancestral form must have provided paternal care, even though only single infants were born, derives from a comparison of litter/mother weight ratios in modern primate species. Twinning perhaps then evolved because of a combination of dwarfing in the callitrichid lineage, leading to higher litter/mother weight ratios, and a high infant mortality rate, and because the extensive paternal care already present facilitated the raising of twins. I propose that the helping behavior of older offspring may have coevolved with twinning, because helpers would have increased the chances of survival of twins, and the presence of twins would have increased the benefits of helping. Finally, the high costs of raising twins and the variability of group compositions, especially the fact that some groups would not have had older offspring to serve as helpers, may have selected for facultative polyandry in saddle-back tamarins (Saguinus fuscicollis) and perhaps in other callitrichid species. Both helping and cooperative polyandry have been extensively studied in bird species, and I apply some of the conclusions of these studies to the discussion of the evolution of callitrichid social systems.     

Oral health promotion among older persons and their care providers in a nursing home facility

Objectives: To assess oral health status and oral health‐related quality of life (OHRQoL) of residents in an extended care facility and to assess the care providers’ oral health attitudes and knowledge. Methods: Participants included 137 residents (58.1% female, age range 32–94 years, 91% African–American) and 22 care providers. Residents received an oral examination and completed the Oral Health Impact Profile (OHIP‐14), an OHRQoL questionnaire. Care providers completed an oral health knowledge (OHK) questionnaire before and after the on‐site geriatric oral health education and training programme. Results: Oral examinations showed that 58% of the residents had extensive oral health needs. On the OHIP‐14, the mean severity was 9.2 (SD = 12.0), extent (number of items rated as ‘fairly often’ or ‘often’) was 1.2 (SD = 2.6) and prevalence (participants rating at least one item at least ‘fairly often’) was 37.8%. Most prevalent negative impact items were about ‘oral pain’, ‘appearance’ and ‘self‐consciousness’. Regarding OHK, caregivers’ knowledge improved following instruction from 65% correct on the pre‐test to 90% correct on the post‐test (p < 0.05). Subsequent to the eight in‐service workshops, providers reported that physical limitations, fear of getting bitten and time constraints were barriers to providing oral hygiene to their residents. Conclusion: Examination data showed a high level of dental needs among the majority of residents, accompanied by significantly reduced OHRQoL. Although care providers’ OHK improved following the geriatric service programme, they reported specific barriers regarding their provision of oral hygiene care to the residents.     

Rates of health services use among residents of retirement homes in Ontario: a population-based cohort study

Background:Because there are no standardized reporting systems specific to residents of retirement homes in North America, little is known about the health of this distinct population of older adults. We evaluated rates of health services use by residents of retirement homes relative to those of residents of long-term care homes and other populations of older adults.Methods:We conducted a retrospective cohort study using population health administrative data from 2018 on adults 65 years or older in Ontario. We matched the postal codes of individuals to those of licensed retirement homes to identify residents of retirement homes. Outcomes included rates of hospital-based care and physician visits.Results:We identified 54 733 residents of 757 retirement homes (mean age 86.7 years, 69.0% female) and 2 354 385 residents of other settings. Compared to residents of long-term care homes, residents of retirement homes had significantly higher rates per 1000 person months of emergency department visits (10.62 v. 4.48, adjusted relative rate [RR] 2.61, 95% confidence interval [CI] 2.55 to 2.67), hospital admissions (5.42 v. 2.08, adjusted RR 2.77, 95% CI 2.71 to 2.82), alternate level of care (ALC) days (6.01 v. 2.96, adjusted RR 1.51, 95% CI 1.48 to 1.54), and specialist physician visits (6.27 v. 3.21, adjusted RR 1.64, 95% CI 1.61 to 1.68), but a significantly lower rate of primary care visits (16.71 v. 108.47, adjusted RR 0.13, 95% CI 0.13 to 0.14).Interpretation:Residents of retirement homes are a distinct population with higher rates of hospital-based care. Our findings can help to inform policy debates about the need for more coordinated primary and supportive health care in privately operated congregate care homes.

In the continuum of care services and settings for older adults lies home care at one end and long-term care at the other.¹ Home care services may include, but are not limited to, nursing care, personal care, homemaking services, and physiotherapy and occupational therapy for older adults who live independently in their community. Home care services are publicly funded under the Ontario Health Insurance Plan (OHIP).^2,3 Long-term care homes provide access to 24-hour nursing and personal care and operate at full capacity in Ontario, with waiting lists of 6 months or longer before an older adult in the community could receive an offer for a bed.^2,4 Retirement homes are thought to fit between home care and long-term care in this continuum.¹Retirement homes are referred to as assisted-living facilities in other North American jurisdictions, and they are private, congregate living environments that deliver supportive care to adults who are 65 years of age and older.^3,5,6 These homes are often marketed to provide a lifestyle and community, and they provide a range of assisted-living care services (e.g., meals, nursing services, etc.).^5,7 Retirement homes predominately operate on a private, for-profit business model, and the room, board and services are purchased by residents.^3,5 In Ontario, retirement homes are regulated through an independent, not-for-profit regulator (i.e., Retirement Homes Regulatory Authority [RHRA]).⁵ There are more than 700 licensed retirement homes in Ontario with over 70 000 available beds occupied by over 55 000 residents, which is comparable to the number of available beds in the long-term care sector.^3,5,6,8 Retirement homes are legislated differently from long-term care homes and primarily cater to adults who do not require 24-hour nursing care.^1,5,9 Unlike long-term care homes, no standardized reporting system is available to identify and describe residents of retirement homes.¹⁰ These residents are conceptualized as having fewer needs for care because they reside in a congregate care home to support independent living; however, this has been difficult to verify given there are no population-level data.A body of literature from the United States has described residents of assisted-living facilities and the sector,^11–17 but Canadian literature is comparatively nascent. Canadian studies have investigated transitions to a long-term care home, risk of hospital admission among those who live with dementia, and life events and health conditions associated with the transition to a congregate care setting.^7,9,18–20 At present, a Canadian population-level cohort of residents of retirement homes that describes the individual-level characteristics and use of health services of the older adults who reside in these homes appears to be lacking. Therefore, it is difficult to position this sector in the gradient of services and housing options for older adults in Canada.We created a population-level cohort of residents in retirement homes and sought to evaluate their rates of health services utilization relative to residents of long-term care homes and other populations of older adults (i.e., home care recipients and community-dwelling older adults) in Ontario.     

Comprehensive DNA barcoding of the herpetofauna of Germany

We present the first comprehensive DNA barcoding study of German reptiles and amphibians representing likewise the first on the European herpetofauna. A total of 248 barcodes for all native species and subspecies in the country and a few additional taxa were obtained in the framework of the projects ‘Barcoding Fauna Bavarica’ (BFB) and ‘German Barcode of Life’ (GBOL). In contrast to many invertebrate groups, the success rate of the identification of mitochondrial lineages representing species via DNA barcode was almost 100% because no cases of Barcode Index Number (BIN) sharing were detected within German native reptiles and amphibians. However, as expected, a reliable identification of the hybridogenetic species complex in the frog genus Pelophylax was not possible. Deep conspecific lineages resulting in the identification of more than one BIN were found in Lissotriton vulgaris, Natrix natrix and the hybridogenetic Pelophylax complex. A high variety of lineages with different BINs was also found in the barcodes of wall lizards (Podarcis muralis), confirming the existence of many introduced lineages and the frequent occurrence of multiple introductions. Besides the reliable species identification of all life stages and even of tissue remains, our study highlights other potential applications of DNA barcoding concerning German amphibians and reptiles, such as the detection of allochthonous lineages, monitoring of gene flow and also noninvasive sampling via environmental DNA. DNA barcoding based on COI has now proven to be a reliable and efficient tool for studying most amphibians and reptiles as it is already for many other organism groups in zoology.     

Hip Hop Aesthetics and the Will to Culture1

In this paper, based upon my field work with the self-styled ‘Hip Hop Community’ in Sydney, in the early 1990s, I examine the material processes by which ‘cultural’ significance is articulated to a number of key practices, specifically, break-dancing, rapping and graffiti. I argue that these practices are understood, within the scene, as being aesthetic practices, which operate to mimetically ‘represent’ a pre-existing cultural essence—Hip Hop. Using a Peircian semiotic model, I argue that the maintenance of performances of these key Hip Hop practices functions over time, within the Hip Hop community, to affirm the legitimacy, authenticity and reality of the idea of Hip Hop.     

Unemployment,deindustrialization, and ‘community economy’ in eastern Germany

Drawing from an evening of fieldwork at an eastern German Protestant churchin the rapidly deindustrialized city of Leipzig, this article finalyzes a discussion among church leaders, former ‘dissidents,’ and unemployed workers on the subject of ‘community economy’ (Gemeinschaftsökonomie), a concept people interpret to represent a potential solution to the crisis of mass unemployment. Such local debates on unemployment offer a frame for understanding the re-negotiation of labor and social welfare in eastern Germany following socialism's end. finalyzing this discussion within the context of theoretical debates on ‘civil society,’ I follow Burawoy's and Gramsci's lead in fillustrating that the imagined economic sphere of ‘community economy’ is an ideological battle ground, where hegemonic discourse supporting economic neoliberalism may be either reinforced or subverted.     

Seasonally Variable Eusocially Selected Traits in the Paper Wasp, Mischocyttarus mexicanus

The expression of alternative traits that benefit eusocial individuals but are not directly involved in reproductive differences among those individuals, which I call ‘eusocially selected traits’, may vary in response to environmental changes if this increases an individual's inclusive fitness. In this study, I describe traits that separate individuals within the reproductive division of labor of Mischocyttarus mexicanus, a eusocial paper wasp, and determine whether observed eusocially selected traits vary across seasons. I examined M. mexicanus because females initiate new nests throughout most of the year where they experience different conditions depending on the season. Findings from this study suggest two main conclusions: (1) phenotypic differences among M. mexicanus females are mixed, showing specialized, generalized, and context‐dependent eusocially selected traits and (2) a female's position within the reproductive division of labor may be influenced by its state. The presence of context‐dependent traits, e.g. large females initiated solitary nests in the spring and grouped nests during the summer, suggests that the payoff for pursuing different positions within the reproductive division of labor changes across seasons. The expression of context‐dependent eusocially selected traits also suggests that, roles, instead of castes, may better reflect the reproductive division of labor among individuals of eusocial species like M. mexicanus.     

Epidemics in nonrandomly mixing populations: a simulation

Two stochastic, discrete-time simulation models for the spread of an epidemic through a population are presented. The models explore the effects of nonrandom mixing within the population and are based on an SIR epidemic model without vital statistics. They consider a population of preschool children, some of whom attend child care facilities. Disease transmission occurs both within the home neighborhood and at the child care facility used, if any. The two models differ in population size used, population density, the proportions of children using different kinds of care, and the functions used for calculating the probability of disease transmission. Results are presented for seven different variables--length of the epidemic in weeks, number of cases, number of cases in each kind of care (two day care centers, private homes, and children staying at home), and the number of private home providers affected by the epidemic. In addition, the distribution of total epidemic size and the progress of an epidemic are estimated from 25 epidemic trials. The effects of the location of homes of initial cases, the type of care used by initial cases, and the density of the population are discussed. Results from the simulation confirmed the importance of type of care on the risk for disease transmission. Results from all runs of the simulation showed that children who attended a day care center were most likely to become infected, children who went to a private home were intermediate, and children who did not use any day care facility were at the lowest risk. The size and length of the epidemics were related to the presence of the disease in day care centers, regardless of the location of the initial case, and the time at which the disease entered the center(s). The simulations also showed that the geographical distribution of the homes of children attending a particular center was a critical feature involved in the production of epidemics. The center with more widely distributed homes of students was less likely to experience a major epidemic than the center with clustering of student's homes within a neighborhood. This indicates that it is not simply attendance at a day care center that is critical for disease spread, but that the nature of the population of children attending a center is also of critical importance in the actual risk for disease spread within the center. These results are discussed with reference to the spread of hepatitis A among day care centers in Albuquerque, New Mexico.     

Kwaliteit van leven bij dementie

Different definitions of quality of life (QOL) are found in the literature. This raised the question which domains are viewed as really important by persons with dementia. In an explorative study the opinions of persons with dementia (community-dwelling and living in nursing homes), were compared to those of professional carers and instruments for QOL in dementia. Data were gathered through interviews, focus groups and literature study. Most QOL-domains mentioned as important by persons with dementia were also acknowledged by carers and in measurement instruments. Some domains, however, were not mentioned by the carers (‘sense of aesthetics’, ‘financial situation’, ‘being useful’ and ‘spirituality’), or not selected in the measuring instruments (‘security and privacy’, ‘self-determination and freedom’, ‘being useful’ and ‘spirituality’). This indicates differences in perspectives on quality of life between persons with dementia, professional caregivers and researchers. Subsequently it was studied to what degree professionals focus on the QoL-domains that persons with dementia consider essential. Caregivers working on 29 units and 3 day care facilities of 13 nursing homes and in 12 meeting centers filled out a questionnaire (N=374). They reported to focus at least to some degree on most domains considered important by persons with dementia. However, little attention was paid to the domains ‘financial situation’ and ‘being useful’. Professionals offering daytime activities focused more than 24-hour care staff on ‘attachment’, ‘enjoyment of activities’, ‘sense of aesthetics’, and ‘being useful’ This article is a translation and merging of 1) Dröes et al. Quality of life in dementia in perspective; an explorative study of variations in opinions among people with dementia and their professional caregivers, and in literature. Dementia: The International Journal 2006; 5 (4): 533–558, and 2) Gerritsen et al. Differences in perspective: do professional caregivers focus on the Quality of life domains that are important for people with dementia? American Journal of Alzheimer’s Disease and Other Dementias 2007; 22:176–183.