Table 2

Examples of key CMO configurations with supporting evidence for ‘transition to a post-liminal state’

Context (C)-Mechanism (M)-Outcome (O)Example of supporting evidence from the literature
CMO: In the context of dementia being perceived as ‘death in the realm of the living’ (C), people with dementia and their wider social network experience fear and trepidation (M) that moves people into a state confined by the shadow of the ‘fourth age’ (O) Death in the realm of the living : ‘Dementia confronts because it seems to bring death into life, implicitly questioning what life, relationship, and death are about.’ 3
Fear ‘people with dementia are often thought of as tragic, robbed of life, and having lost their personhood. 3
The fourth age ‘It is when people are no longer ‘getting by’, when they are seen as not managing the daily round, when they become third persons in others’ age-based discourse, within others’ rules, that they become subjects of a fourth age’ 102
CMO: In communities of identity (C), people with dementia have a sense of purpose (M), which allows them to grow and maintain a role as an active citizen (O) Communities of identity ‘This centre provides day care for those living with dementia but instead of playing games or receiving passive entertainment the main program is about the design and production of the mid-day meal. Seniors with dementia are asked to jointly design the meal, then to go out shopping together to buy the ingredients, and then return to help prepare the meals. Shopkeepers are briefed on the program and willingly participate in the program, learning and experiencing the complexities of communicating with seniors with dementia and also Compassionate communities gaining insight into the complexities of their care while sharing this in a small way.’ 54
CMO: As dementia progresses, a person may change their perceptions and views on various issues (including death) (C), they maintain their role as an active citizen (O) by conveying these views through their agentic influence (M) Changing perceptions : ‘Relatives and staff need to be aware that the person’s attitude to death may evolve during their dementia. When a comparison was made between participants’ attitudes to death and those ascribed to them by their family carers, for some people they appeared to have changed.’ 66
‘(Husband) had a bit of a health crisis about 12 months ago…when he came out of this acute crisis, he said to me he was afraid people that people would turn off the switch. So there was a complete change of his limited understanding…(now) I don't know whether I'm actually fulfilling his wishes.’ 53
  • The full list is available in the online supplementary file.