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Non-pharmacological interventions in dementia Simon Douglas, Ian James and Clive Ballard Simon Douglas is a clinical research nurse at the Wolfson Research Centre in Newcastle upon Tyne. He is currently coordinating a number of studies, particularly on dementia in nursing and residential homes and providing input into a new trial of non-pharmacological interventions for dementia. Ian James is a consultant clinical psychologist at the Centre for the Health of the Elderly at Newcastle General Hospital and a
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Side-effects such as sedation, falls and extrapyramidal signs are well-known, and more recent work indicates that neuroleptic treatment of dementia leads to reduced well-being and quality of life (Ballard et al, 2001) and may even accelerate cognitive decline (McShane et al, 1997).
In this article we discuss the types of behavioural and psychological symptoms that are appropriate for intervention, and then examine the current use of non-pharmacological interventions. The article is intended to apply to all common late-onset dementias and to no subtype in particular.
We carried out an extensive review of the literature on non-pharmacological treatments for dementia using Medline and other related searches, but this is not intended to be a formal systematic review.
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The nature of the behavioursWhen reviewing this area, it is important to note that there is an ongoing debate regarding the definitions and basic terminology for ‘non-cognitive’ symptoms. The term currently favoured in the psychiatric literature is ‘behavioural and psychological symptoms of dementia’, but most of the psychology community still use the label ‘challenging behaviour’ (Emerson et al, 1995). Within these broader terms, further distinctions have been made (e.g. Cohen-Mansfield et al, 1992; Allen-Burge et al,
Patient living in the nursing homes with diagnosis of dementia experience Disruptive behavior. According to Burton et al. (2015) more than 44 million people have dementia. Dementia affects memory, thinking and social abilities. These symptoms severely interfere with daily functioning of the patient. Approximately 90% of dementia patients demonstrate psychological and behavioral symptoms such as anxiety, agitation, depression, hallucination, delusion, and aggression (Chen et al., 2014). Behavioral and psychological symptoms of dementia (BPSD) are a varied group of non-cognitive symptoms affecting demented patients. These symptoms are delusion, hallucination, agitation, anxiety, euphoria, disinhibition, night-time behavioral disturbances
Non-pharmacological interventions, such as validation therapy, are the first line approach to manage BPSD. However, in emergency cases where there is safety risk for the person with dementia and others, the pharmacological intervention or psychotropic drug are used. Psychotropic drug includes neuroleptics, anxiolytics and antidepressants. Additionally, to improve cognitive function, memory enhancement drugs such as cholinesterase inhibitors are
Dementia is an umbrella term used to explain the gradual decline in multiple areas of functions, which includes thinking, perception, communication, memory, languages, reasoning, and the ability to function (Harrison-Dening 2013). Worldwide, 47.5 million people have dementia and there are 7.7 million new cases every year. Alzheimer's disease is the most common cause of dementia and may contribute to 60–70% of cases. (Alzheimer's society 2014). The complexity of dementia presents a number of behavioural challenges to those who live with dementia and their care providers. Aggressive behaviour seems to be one of the most prevalent challenging behaviours in the different stages of dementia (Weitzel et al 2011). As acute care
The term ‘dementia’ is used to describe a syndrome associated with an ongoing decline of the brain and its abilities. This includes problems with memory loss, thinking speed, mental agility, language, understanding, and judgment. People with dementia can become apathetic or uninterested in their usual activities, and have problems controlling their emotion. They also fine social situation challenging, lose interest in socialising and aspect of their personality may change. The majority of people who are diagnosed with dementia have either Alzheimer’s disease or vascular dementia, or a combination of the two. (Source 1) As the disease progresses, the person experiencing dementia becomes more vulnerable and their needs often complex; which requires appropriate care and management (Kitwood, 1997).this leads me to the next distinctive feature of patients with dementia.
Certain qualities are consistently observed in the Alzheimer’s victim. These dysfunction’s, though, are not exclusive to Alzheimer’s disease. Consequently, declaring Alzheimer’s by these parameters is a matter of degree rather than an absolute. Characteristic dysfunction’s have been noted in Alzheimer’s victims, but the degree and severity of these varies from patient to patient. Thus, evaluation of the patient’s mental status must be made based on the sum, rather than a single characteristic. Memory is one of the first noticed deficiencies, beginning typically with the recent and short term memory, and progressing from there as the disease grows more severe. In addition, deterioration in language skills, attention span, praxis (performance of an action), and visuospatial skills are commonly seen. Also observed are changes in the actions and personality of the Alzheimer’s victim. These include changes in mood, motor activities, activities of daily living, socialization skills, psychotic disturbances, vegetative symptomology, and rise in anxiety levels. Again, the
The term ‘dementia’ describes a set of symptoms which can include loss of memory, mood changes and problems with communication and reasoning. These symptoms occur when the brain is damaged by certain conditions and diseases, including Alzheimer’s disease, vascular dementia and Creutzfeldt-Jakob disease. Age is the greatest risk factor for dementia. Dementia affects one in 14 people over the age of 65 and one in six over the age of 80. However, dementia is not restricted to older people: in the UK, there are over 17,000 people under the age of 65 with dementia, although this figure is likely to be an underestimate.
Dementia does not only impact the people with symptoms and it also disturbs the people who must care for the person. It is estimated that 1.2 million people are involved in the care of people with dementia. It has a financial burden on the Australian economy $4.9 billion in 2009-10. (1)
Dementia which was views as a disease is now viewed as a disability. It allows us to view people with dementia as individuals coping with their own impairment and entitled to an adequate quality of life and comfort. To do this it is necessary for us to shift our way of thinking from focusing on dementia as a disease that degenerative without a cure, to focusing on the whole person and seeing dementia as a disability of certain parts of the persons
By 2015, it is estimated that there will be a number of 850,000 dementia sufferers in the UK and about 225,000 people develop dementia every year in which it is roughly about one person in every three minutes. It is predicted that the number of people with dementia will exceed 2 million in 2050 if preventative measures are not taken. In brief, dementia can be described as a persistent and progressive loss of mental ability due to brain diseases or injuries in which the symptoms can be recognized by memory disorders, perception and personality changes and also impairments of body functions. Alzheimer is the most common type of dementia which contributes about 62% of the cause of dementia and had become a global prevalence disease. By 2015, it
As people get old a few of them will experience changes in cognition with age related capacity rather than intellectual capacity. There are some people who get both disparities of mentally and physically impaired that will led into depression due to aging process of their body. Even though, the forgetfulness is a common among older adults, we as healthcare providers must evaluate altered mental status of the patients. “The evaluation and management of altered mental status are broad and require careful history and physical examination to eliminate life-threatening situations”(Patti & Dulebohn, 2017). Therefore, it is very important to recognize the importance of difference between normal age-related symptoms and developing new health problems that can arise in this specific population. As elders get older their memory lapses it frustrating to them leading them to be more worried about changes in their memory. Nurses have a unique capability to promote a cognitive health and determine the possibilities of potential cases of the impairment in elders. The movie “On Golden Pond” Mr. Norman was a perfect example and showed that his symptoms were interfering with his everyday live when he almost burns down the house with fire, calling Bill by his daughter’s name Chelsea and getting lost in on the lake. Even though, Mr. Norman had heart and dementia problems his wife never discouraged him to do what he liked such as
This essay will aim to introduce the term dementia including the types, causes, prevalence, young onset and models of care. This essay will continue to address what skill could be implemented to provide person centred care with understanding of health promotion and recovery concepts.
Dementia is an extremely common disease among the elderly, with 4 million Americans currently suffering from the Alzheimer’s type alone. Figures show that 3% of people between the ages of 65-74 suffer from the disease, rapidly increasing to 19% for the 75-84 age bracket, and as high as 47% for the over 85s. Therefore, it is easy to see why Dementia is such a large part of many people’s lives, whether they are suffering from the condition themselves, or have an elderly relative who requires full time care just to undertake simple day to day tasks. The disease can be extremely traumatic for the patient and their families, as the person, who may have been extremely lively and bright throughout their
Dementia is characterized as a condition where the mental processes of cognition and memory start to deteriorate. It is described as a syndrome that hinders the daily lives of those who have it and is characterized by memory and thinking impairment. The most common form of dementia is Alzheimer’s Disease and the second most common is vascular dementia. Dementia is a syndrome occurring usually, but not limited, to people over the age of 40 and is due to brain damage caused by natural deteriorating, stroke or can be brought on by factors such as excessive drinking or drug abuse. Dementia is best cared for in its early stages and, therefore, an early diagnosis is essential. Recognizing the symptoms by both the dementia patient and the
Alzheimer's Disease is a condition that affects 50% of the population over the age of eighty five, which equals four million Americans each year. It is becoming an important and high-profile issue in today's society for everyone. There are rapid advancements being made in the fight against this disease now more than ever, and the purpose of this essay is to educate the public on the background as well as the new discoveries. There are many new drugs that are being tested and studied every day which slow down, and may even halt the progress of the disease.
The incidence of dementia increases as the general population ages and one source estimates approximately two billion individuals being affected by the year 2050 (Vasionyte & Madison, 2013). The nature of dementia results in cognitive decline that may lead to inappropriate behaviors, such as aggression, agitation, mood disorders, and eating problems, which can be a severe impairment when treating these patients