Elucidating the process by which family members managed growing incompetence sheds light on the important role of awareness perception in household dementia care. Currently, there exists an extensive literature examining clinical dimensions of declining deficit awareness or anosognosia, including its detection and measurement, especially for diagnostic purposes , cognitive correlates and the nature of its expression, including its fluctuations and effects on self . Despite these research gains, there are currently few studies that address the impact that perceived anosognosia has on family care giving and none that elucidate the social process by which it occurs. Related work, for instance, shows that anosognosia is associated with increased caregiver burden . The current study extends this area of research by showing the central role that lay perceptions of awareness play in efforts to manage growing incompetence in everyday activities. It explains the social mechanism by which the perception of declining awareness transforms care from a collaborative pursuit with the declining individual into a unilateral pursuit utilizing an array of tricks and ruses to influence the individual’s activity choices. The study’s naturalistic design helps show the importance of the interpretive process in assessing the household impact of a clinically-defined symptom, suggesting one reason why the clinical presence of anosognosia would not always translate into caregiver burden. This study’s insight about the interpretive challenges that families encounter around deficit awareness holds important epistemological implications for a common clinical approach to identifying and measuring anosognosia. The approach measures deficit awareness using discrepancy scores generated by comparing the elder’s self-rated scores on daily functional abilities with the scores rated by a caregiver . In this approach, vertical gardening in greenhouse the caregiver’s rating is treated as an accurate assessment and its discrepancy with the elder’s score reveals to what extent he or she is not aware of his or her own ability decline.
The current study however, suggests that there can be problems with treating the caregiver’s report as fully reliable. The findings show that caregivers may sometimes have difficulty grasping an individual’s level of decline. First, family members themselves may suffer from a kind of courtesy anosognosia, a state in which they are unwilling or unable to admit to the extent of a loved one’s decline. Multiple family members in this study, for instance, reported that the individual’s decline was denied by others in the household when met with arguments or plausible evidence to the contrary. Second, family members also signaled interpretive troubles by describing moments when elders employed a likely cover-up tactic to hide small errors in ability. They attempted to hide errors by taking issue with or showing nonchalance around what others defined as a “correct” procedure for accomplishing a task. In this way, affected individuals attempted to resist or redefine normative measures of successful activity engagement. One family member, for instance, suspected this maneuvering when her mom served her dad cold soup and claimed that he liked it that way. Another participant reported her dad’s nonchalance or apparent lack of care after she pointed out that he did not have to have coffee with the grounds in the coffee cup.Facing a disease that is deeply stigmatized, individuals with Alzheimer’s have social and psychological reasons as to why they would hide their awareness of errors in ability from others . Efforts taken to avoid acknowledging the disease’s effects, for instance, may signal the elder’s effort to protect him or herself from social and/or psychological injury . While these interpretive obstacles pose challenges to using caregiver reports of ability level, this study suggests that to better understand the interpretive challenges that observers face and thus the reliability of observer reports, researchers must better understand the social process in which the interpretations are made. These findings call for more research around the interpretive challenges that proxy raters may encounter. While researchers have highlighted the issue of duplicity in care giving and the kinds of ethical dilemmas it can create , the current study identifies the turning point in the social process of care when family members began using duplicitous techniques.
The evidence shows that they began using these techniques as a self-conscious strategy when the elder’s awareness ability was thought to have declined severely enough to make transparent negotiation difficult. At this point in the progression of declining deficit awareness, family members found that elders were less capable of heeding their warnings and following their instructions for avoiding activities that had become too dangerous to pursue independently. At this stage, family members resorted to techniques that function as ruses to fool or trick elders away from risky activities. This study has two important limitations. First, the participant sample is almost entirely made up of adult-children. It is likely that adult-children will experience a more protracted and potentially more risky transition period between collaborative and unilateral autonomy management work in contrast to spousal caregivers. Adult-children commonly must make decisions in concert with other siblings or family members. Negotiating with multiple members may raise the likelihood of disagreement and conflict that can delay a decision to curtail an elder’s independence when it is urgently needed. In addition, spouse caregivers likely will have spent many more years in close proximity with the affected individual and be better suited to notice minute, yet critical changes in the individual’s awareness level that can lead to timely changes in their autonomy management practices. Second, the participant sample only includes family members dealing with individuals who have one type of dementia: Alzheimer’s. While there are important differences in symptom behaviors between dementia sub-types , we believe that these results would extend to families dealing with vascular, Lewy body, and frontotemporal dementias. Future research can test the extent to which features of the autonomy management process identified within the Alzheimer’s context can effectively explain features of the support process around other forms of dementia. This study reveals the social contextual factors that influence how family members identify and respond to growing signs of risk in an elder’s decades-old activities. Across theautonomy management process, family members attempted to balance their concerns of reducing risk with their concerns of permitting enough autonomy to promote wellbeing. In limiting an elder’s activities too much, for instance, they feared they could reduce his or her chances of finding spontaneous sources of meaningful engagement and potentially cause friction within their relationship. Yet in limiting their activities too conservatively, family members feared they could inadvertently permit elders to injure themselves and possibly others. Autonomy management provides a useful conceptual framework for understanding how family members adjusted their measures to deal with this dynamic as the disease advanced.The fresh market berry industry in Santa Cruz and Monterey counties is an excellent example of transformation in the business of agriculture over the last 50 years. Located along the Central Coast of California, the two counties span the fertile Pajaro and Salinas valleys, and are well known for their amenable climate and production conditions, their diverse crop mix and grower demographics, and their developed agricultural infrastructure and support industries. The majority of the berry sector is comprised of strawberries , raspberries and blackberries , with blueberries and other miscellaneous berries produced on a much more limited basis. Substantial research-based literature and historical information is available for Central Coast strawberries; however, despite the area’s move towards greater production of raspberries and blackberries, less information exists for these crops. We seek here to provide a more complete portrayal and historical context for the berry industry in the Santa Cruz and Monterey area, greenhouse vertical farming which is the origin of the berry industry in California. While the berry industry has been very successful in recent decades, it now faces new challenges, such as invasive pests and the phaseout of the soil fumigant methyl bromide. This article draws on previous and more recent research to discuss some of the influences that have contributed to the berry industry’s dramatic expansion in Santa Cruz and Monterey counties, including selected innovations in agricultural practices and heightened consumer demand.During the 1960s and 1970s, the number of acres planted to berries, tons produced and value of production fluctuated.
The fluctuations can be partly explained by farm management: in the past growers often rotated berry and vegetable crops to assist with soil and pest management, thereby influencing these statistics. However, annual crop reports from the county agricultural commissioners show that since the 1980s, berries have become increasingly important to each county’s overall value of production, and by 2014 accounted for 64% and 17% of the total value of all agricultural products in Santa Cruz and Monterey counties, respectively . The industry’s growth can be explained by a shift of some acreage out of tree fruits and field crops , among others, into berries, and by additional acreage put into agricultural production.Strawberries are the undisputed leader in the berry sector and in 2014 represented 58% and 94% of the value of all berry production in Santa Cruz and Monterey counties, respectively , and 50% and 93% of all berry acreage . Table 2 documents the remarkable expansion of the strawberry industry over time in both counties with respect to acreage, tons produced and value of production. Between 1960 and 2014, acreage more than tripled and production increased tenfold. The value of production, in real dollars, increased by 424% in Monterey County and by 593% in Santa Cruz County, reaching an astonishing combined value of nearly $1 billion in both 2010 and 2014. The gains in all statistical categories in Monterey County were enabled in part by an expansion of production into the southern reaches of the county where more and larger blocks of farmland are available, and where land rents are lower than in Santa Cruz and northern Monterey counties. However, from 2010 to 2014 Monterey County’s tonnage and production values declined, possibly because the area has recently experienced a shortage of labor to harvest fresh market crops. Tonnage was also lower in Santa Cruz County, but production values increased. This may be because of the county’s greater emphasis on local agriculture, organic production and direct market sales, which are often associated with higher crop values. For raspberries, the acreage, tons produced and value of production grew steadily and most strikingly in Santa Cruz County , where production conditions for caneberries are optimal. For example, caneberry fields in Santa Cruz County are situated in areas that have well-drained soils and are protected from damaging winds. Also, fields are planted to take advantage of the growth and yield gains associated with southern exposures. Moreover, field-to-cooler travel distances are shorter in Santa Cruz County, which is critical for safeguarding the quality and marketability of these highly perishable crops. By 2014, raspberries represented 33% of the county’s total value of production for all berries. In contrast, Monterey County raspberry production accounted for only 6% of the county’s total berry value. Blackberries have not been consistently reported as a separate category in archived statistical analyses, but instead were often included under the terms “bush- or miscellaneous berries”. Therefore, similar data for blackberry acreage and value of production cannot be reported here. However, between 1990 and 2010, Santa Cruz County agricultural commissioner crop reports reported an upward trend for the broad category with respect to acreage planted and value of production . In 2010, blackberries were promoted to a position of prominence in the report and shown as a separate statistic; at the same time, the miscellaneous berry category was shown to be very small indeed. Between 2010 and 2014, however, blackberry acreage and value of production leveled off and have shown only modest gains . This may be because there has been less emphasis on production and market research and promotion for blackberries than for strawberries or raspberries. No comparable data are available for Monterey County. The two counties have contributed significantly to California’s total berry sector: in 2014, area strawberry acreage represented 35% of the statewide total, 37% of the total tons produced and 38% of the total value of production . Area raspberry acreage represented 43% of the statewide total, 42% of the total tons produced and 39% of the total value of production. Comparable statewide statistics are not available for blackberries. County agricultural commissioners’ reports show that the majority of all berries produced in the two counties — up to 98% — are sold as fresh market fruit .