{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T03:24:57Z","timestamp":1789010697892,"version":"build-2803163510"},"reference-count":43,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Canadian Graduate Research Scholarship\u2014Doctoral Award","award":["DTA-210012"],"award-info":[{"award-number":["DTA-210012"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Dementia"],"abstract":"<jats:p>Health-related quality of life reflects individuals\u2019 perceptions of how a health condition affects their physical, psychological, and social functioning. Amid increasing pressures on primary care systems, people living with dementia are presenting more frequently to hospital settings. However, limited research has explored how hospital-based care, and the dementia stigma that may operate within it, shapes health-related quality of life for people living with dementia and their caregivers. This exploratory qualitative study involved semi-structured interviews with 15 participants, including people living with dementia and caregivers of individuals who had attended an emergency department or been hospitalized in Canada within the past two years. The interview guide was informed by the Wilson and Cleary Model of Health-related Quality of Life and intentionally avoided terms such as \u201cstigma,\u201d \u201cbias,\u201d or \u201cdiscrimination\u201d to reduce response priming. Data were analyzed using Fairclough\u2019s critical discourse analysis and mapped to health-related quality of life factors (i.e., characteristics of the individual, biological and physiological factors, general health perceptions, etc.). Twelve caregivers (mean age 59.8\u00a0years, standard deviation = 9.7) and three people living with dementia (mean age 70.6\u00a0years, standard deviation = 11.8) participated between September and December 2025. Five interrelated discourses emerged: (1) characteristics of the individual: identity precedes clinical assessment; (2) biological and physiological factors: dementia disclosure as double-edged; (3) symptom and functional status: diagnostic overshadowing; (4) general health perceptions: equating dementia to futility; and (5) characteristics of the environment: structural barriers to recovery. Hospital-based discourses that implicitly or explicitly associate dementia with decline and therapeutic futility may contribute to stigma and negatively influence health-related quality of life for people living with dementia, while also intensifying caregiver distress. These findings underscore the need for stigma-reduction strategies in acute care settings that challenge therapeutic nihilism (i.e., inappropriately pessimistic view of patient outcomes) and promote person-centered, equitable hospital care.<\/jats:p>","DOI":"10.1177\/14713012261485342","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T21:40:23Z","timestamp":1787866823000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["\u201cYou Don\u2019t Belong in Hospital\u201d: How Hospital-Based Dementia Stigma Shapes Health-Related Quality of Life"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5509-8960","authenticated-orcid":false,"given":"Alixe","family":"M\u00e9nard","sequence":"first","affiliation":[{"name":"University of Ottawa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackda","family":"Donkor","sequence":"additional","affiliation":[{"name":"University of Ottawa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Fraser","sequence":"additional","affiliation":[{"name":"University of Ottawa"},{"name":"The Canadian Consortium on Neurodegeneration in Aging"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_3_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1440-1630.70032"},{"key":"e_1_3_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2025.118560"},{"issue":"2","key":"e_1_3_7_4_1","first-page":"160","article-title":"Physicians\u2019 attitudes and confidence toward dementia care: A cross-sectional study at primary healthcare facilities in the Eastern Province, Saudi Arabia","volume":"31","author":"Al-Awad F. 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Journal of Family & Community Medicine, 31(2), 160\u2013167. https:\/\/doi.org\/10.4103\/jfcm.jfcm_230_23","journal-title":"Journal of Family & Community Medicine"},{"key":"e_1_3_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-020-01508-8"},{"key":"e_1_3_7_6_1","doi-asserted-by":"publisher","DOI":"10.5770\/cgj.23.426"},{"key":"e_1_3_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnad052"},{"key":"e_1_3_7_8_1","article-title":"Presentation of the clothed self on the hospital ward: An ethnographic account of perceptual attention and implications for the personhood of people living with dementia","author":"Boddington P.","year":"2020","unstructured":"Boddington P., Featherstone K., Northcott A. (2020). Presentation of the clothed self on the hospital ward: An ethnographic account of perceptual attention and implications for the personhood of people living with dementia. 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