An interpretative phenomenological analysis (IPA) of coercion towards community dwelling older adults with dementia: findings from Mysore studies of natal effects on ageing and health (MYNAH).
Limited availability of specialist services places a considerable burden on caregivers of Persons with Dementia (PwD) in Low- and Middle-Income Countries (LMICs). There are limited qualitative data on coercive behavior towards PwD in an LMIC setting.



The aim of this study was to find relevant themes of the lived experience of relatives as caregivers for PwD in view of their use of coercive measures in community setting in South India.



Primary caregivers (n = 13) of PwDs from the Mysore study of Natal effects on Ageing and Health (MYNAH) in South India were interviewed to explore the nature and impact of coercion towards community dwelling older adults with dementia. The narrative data were coded using an Interpretative Phenomenological Analysis (IPA) approach for thematic analysis and theory formation.



Caregivers reported feeling physical and emotional burn-out, a lack of respite care, an absence of shared caregiving arrangements, limited knowledge of dementia, and a complete lack of community support services. They reported restrictions on their lives through not being able take employment, a poor social life, reduced income and job opportunities, and restricted movement that impacted on their physical and emotional well-being. Inappropriate use of sedatives, seclusion and environmental restraint, and restricted dietary intake, access to finances and participation in social events, was commonly reported methods of coercion used by caregivers towards PwD. Reasons given by caregivers for employing these coercive measures included safeguarding of the PwD and for the management of behavioral problems and physical health.



There is an urgent need for training health and social care professionals to better understand the use of coercive measures and their impact on persons with dementia in India. It is feasible to conduct qualitative research using IPA in South India.
Foundation for Research Advocacy in Mental Health (FRAMe), Mysore, India. vijaydanivas@gmail.com.|Northwestern Mental Health, Melbourne, Australia. vijaydanivas@gmail.com.|Broadmeadows Health Centre, 35 Johnstone Street, Broadmeadows, VIC, 3033, Australia. vijaydanivas@gmail.com.
Vijay
V
Danivas
Medical School, University of Southampton, Southampton, UK.
Mufaddal
M
Bharmal
Edge Hill University, Lancashire, UK.
Paul
P
Keenan
Edge Hill University, Lancashire, UK.
Steven
S
Jones
CSI Holdsworth Memorial Hospital, Mysore, India.
Samuel Christaprasad
SC
Karat
CSI Holdsworth Memorial Hospital, Mysore, India.
Kumaran
K
Kalyanaraman
Psychiatric Epidemiology, Institute of Psychiatry, London, UK.
Martin
M
Prince
International Pediatric Epidemiology, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
Caroline H D
CH
Fall
Wellcome DBT India Alliance at Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India.
Murali
M
Krishna
D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D017028:Caregivers / Q000523:psychology*; D003068:Coercion; D003704:Dementia / Q000451:nursing*; D005260:Female; D006801:Humans; D057187:Independent Living / Q000523:psychology*; D007194:India / Q000208:ethnology; D008297:Male; D008875:Middle Aged
Caregiving; Coercion; Dementia; Interpretative phenomenological analysis; Low- and middle-income setting; Narrative methods
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