¶ … dementia disorder and how healthcare professionals embrace theories, research and practical strategies, in order to help dementia sufferers cope with their difficulties.
Behavioral and Psychological symptoms in primary care
Doctors, nurses, other healthcare professionals and caregivers are challenged when it comes to the care of patients suffering from dementia. That is because dementia is frequently accompanied by a variety of neuropsychiatric symptoms, according to a peer-reviewed article in the journal Mental Health in Family Medicine. Those symptoms include "disturbed behavior, thought, mood and perception" (Buhagiar, et al., 2011).
The point of the article was to find out how much confidence that doctors (general practitioners) have as regards their ability to identify and manage the various behavioral and psychological symptoms of dementia. The authors designed a two-page questionnaire and sent it to 160 general practitioners in north Dublin, Ireland. About 109 general practitioners returned the questionnaires (that is a 68% rate of response), and of those 106 were "usable" (Buhagiar, 227).
There were two sections in the questionnaire; the first was strictly designed to gather demographic data, and the second section asked nine questions of the doctors. Those nine questions were designed to evaluate the amount of "confidence" that the doctors reported regarding their ability to manage the behavioral and psychological symptoms of dementia (BPSD), Buhagiar explains (228).
The purpose of this research is theoretical and is based on two facts: a) clinically "significant symptoms" are very common in about 30% of those who suffer from "mild dementia"; and b) general practitioners are dealing "more frequently" with individuals who are experiencing "cognitive decline for the first time" (Buhagiar, 228). The bottom line is that BPSD is not always managed appropriately, and there are often incorrect prognoses given because general practitioners do not necessarily come into contact with dementia patients. However, Buhagiar explains, it is necessary for general practitioners to have knowledge of patients in the early stages of dementia because "…more than one quarter of people over 75" may be showing early signs of dementia.
Management of the "more dramatic forms" of dementia "can be even more daunting" because of the general lack of "clarity" on the symptoms (by general practitioners), and also the lack of "specific pharmacological and non-pharmacological treatments" (Buhagiar, 228). What the authors are saying, frankly, is that because "primary care" does not prepare physicians to give an "optimal quality of care" to individuals with BPSD (Buhagiar, 228).
The results of this scholarly survey showed that: a) only 7.3% of the 106 doctor respondents had undergone "…postgraduate training in geriatric psychiatry or medicine"; b) most general practitioners associated dementia "with memory loss rather than behavioral disturbance"; and c) a "substantial number of the GP's (67.9%)…encounter major difficulty in accessing secondary care services" when they need help managing BPSD (Buhagiar, 231).
In conclusion the authors emphasize that general practitioners do not show a strong level of confidence when it comes to providing care for individuals with serious dementia. Hence, "GPs need to be supported by educational programmes that bolster their confidence" when it comes to the care of people suffering with dementia.
Dementia and its relationship with food
Within the psychopathological milieu surrounding dementia, there are a number of important issues that caregivers, doctors and other healthcare providers must be familiar with. One of those is diet and nutrition, which are vitally important aspects of care for everyone and in particular for older people. Writing in the peer-reviewed British Journal of Community Nursing, author Stephanie Ragdale explains that as people age they lose brain cells (and hence, they require the best possible nutritional support), but when a person is hit with dementia, the loss of brain cells is "catastrophic" (Ragdale, 2014). Hence, it is very important that caregivers and professional healthcare providers approach the question of nutrition with great care and interest.
On page S21 Ragdale, an Admiral Nurse in the UK, writes that a Mediterranean diet that is "rich in unsaturated fatty acids," and features consistent intake of "cereals, fruits, fish, legumes and vegetables" lowers the health risks associated with "vascular dementia." Also, eggs and oily fish are both strong in Vitamin D, which is known to reduce the risk of dementia to begin with (Ragdale, S21).
The reason this article is pertinent is because everyday life for folks with dementia is difficult to begin with, and when the patient with dementia is undernourished, or not eating properly, that can "increase confusion and irritability" in the individual. As for the caregivers who help those with dementia, they may find the patient's inconsistent...
A survey in the United States showed that over an 18-month period some 85.8% of residents in a nursing home "with advanced dementia" had developed a serious eating problem (Ragdale, S23). Some dementia patients have poor nutritional habits and they lose weight because of a loss of appetite. In fact the loss of appetite can result from a loss of the sense of smell and taste among older people; hence, it is important for the caregiver to encourage good eating habits.
Ragdale explains that for those dementia patients whose weight has fallen below normal levels, a theory has been constructed based on a fortified diet for the dementia sufferer. The caregiver can achieve success in helping a very thin dementia sufferer by providing "…high-calorie ingredients" like Vitamin D milk (the fattiest milk available), cheese, butter, oil, yoghurt, cream and mayonnaise along with the patient's regular meal (Ragdale, S24). Also, the caregiver should be serving nutritious drinks such as smoothies, fresh fruit juices, and other milky drinks; moreover, research reflects the fact that there is "strong evidence that oral nutritional supplementation" can and does increase weight, even though the dementia patient may not know that extra calories are supplementing his or her regular diet (Ragdale, S24).
If a dementia patient has "excessive stimulation" in the caregiving environment, that can easily disrupt normal eating habits, Ragdale continues. In fact the meal time should be consistent every day (we have lunch at noon and dinner at 5:30 every day, the patient must be reminded). In addition, providing "clear visual and sensory cues" reduces the potential of disorientation in the dining area; that is, the meals should be attractive, must smell good and taste delicious in order to keep the patient interested in good eating habits (Ragdale, S24).
The author also recommends not robbing people with dementia of their ability to feed themselves; assisting a dementia sufferer with eating can "…lead to a loss of self-esteem and a sense of powerlessness" (Ragdale, S24). Sensitivity to the patient should be the watchword when it comes to helping him or her to eat, and so when families are the caregivers, they must be "…equipped with the knowledge and skills required" (Ragdale, S24).
Musical intervention for patients with dementia
Music therapy is an "attractive form of intervention" for demented patients, and that is not just theoretical -- it is a proven practice, according to a peer-reviewed article in the Journal of Clinical Nursing. In fact music therapy is used in many situations where there are "psychological, psychiatric and physical conditions," and so it is a reasonable assertion that music could be used as an intervention for patients suffering from dementia (Vasionyte, et al., 2013). Especially when pharmacological interventions have not worked as expected, and have led to "undesired side effects," music therapy can be substituted. The authors of this article conducted a meta-analysis on the subject of music as therapy for dementia.
They used the key words "music and dementia," and through databases they accessed nineteen studies with a total of 478 dementia patients. And they determined through this meta-analysis that music interventions "seem to be effective," and moreover, music interventions have the potential of "…increasing the quality of life" for those who struggle with dementia (Vasionyte, 1203).
What exactly is a musical intervention vis-a-vis dementia? Vasionyte explains first that a 1997 study summarized 69 other studies including "clinical empirical studies of music interventions, theoretical and philosophical papers," along with case studies and anecdotal accounts of music therapy (1204). That meta-analysis resulted in the findings that music interventions improved the "social, emotional and cognitive skills"; and music interventions also helped to decrease "behavioral problems among demented people" (Vasionyte, 1204).
The author is quick to differentiate between "mere music listening" and "receptive vs. active music therapy" provided by a trained therapist. Active music therapy involves "active involvement" by the participant; it's not just playing pre-recorded music and having the demented person kick back and listen. Instead, participants in active music therapy may actually play instruments, sing along with music, dance to musical numbers, or engage in "song-drawing" (Vasionyte, 1204).
The therapist selects the music based on the taste of the dementia patient. Active music therapy is used for "arousal of positive emotions and increasing self-confidence," Vasionyte explains (1204). Ideally, the music should be played live…
