Alzheimer, dementia, dimensional analysis, end of life, existential suffering, nurses, spiritual suffering, suffering



  1. Smith, Lenora W. MSN, FNP-BC
  2. Amella, Elaine PhD, RN, FAAN
  3. Edlund, Barbara PhD, RN
  4. Mueller, Martina PhD


Alzheimer disease is 1 of 5 leading causes of death in persons older than 65 years. The term suffering is used in all disciplines and a variety of contexts with no clear universal definition. Identifying dimensions and qualities (dimensional analysis) of the concept of suffering will assist in better understanding the concept and being able to apply it to science and practice. The objectives of this article were to analyze and identify dimensions of the concept of suffering for individuals at end of life who have dementia and to establish relationships between the dimensions. The method of dimensional analysis of Caron and Bower and the symbolic interaction theory guided the analysis. Fourteen research studies were selected from databases including CINAHL, PubMed, Ovid/Medline, Academic Search Premier, and PsycInfo between 2000 and 2012. Key search terms included suffering, dementia, and end of life combined. Four dimensions (pain, holistic, discomfort, and despair) and 2 subdimensions (communication and symptoms) were identified in the analysis. Different perspectives were found in the literature, but each one varied in its approach to the concept of suffering. The concept of suffering is complex and multifaceted and encompasses several dimensions. Understanding the dimensions of suffering provides insight into the individual with dementia as a person and not the disease. The analysis reveals that these dimensions are not well explored in the literature and establishes the importance of further research in this area.