This paper examines how healthcare professionals address dementia through evidence-based theories, research, and practical strategies. It reviews primary care management of behavioral and psychological symptoms, the critical role of nutrition in dementia care, music therapy as a non-pharmacological intervention, the burden experienced by caregivers, dog-assisted therapies, and strategies to encourage social service utilization. Drawing on peer-reviewed research from multiple healthcare disciplines, the paper demonstrates that comprehensive dementia care requires multifaceted approaches combining medical knowledge, behavioral interventions, caregiver support, and alternative therapies to improve quality of life for patients and reduce caregiver strain.
This paper uses available research literature to describe dementia disorder and how healthcare professionals embrace theories, research, and practical strategies to help dementia sufferers cope with their difficulties.
Doctors, nurses, and other healthcare professionals face significant challenges in the care of patients suffering from dementia. This 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 research aimed to determine how much confidence general practitioners have regarding their ability to identify and manage 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. Approximately 109 general practitioners returned the questionnaires (a 68% response rate), and 106 were deemed "usable" (Buhagiar, 227).
The questionnaire contained two sections. The first gathered demographic data, and the second asked nine questions designed to evaluate the doctors' reported confidence regarding their ability to manage behavioral and psychological symptoms of dementia (BPSD). The research was grounded in two key facts: clinical "significant symptoms" are very common in approximately 30% of those with "mild dementia," and general practitioners increasingly encounter individuals 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 frequent contact with dementia patients. However, it is necessary for general practitioners to have knowledge of patients in early-stage 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 and also the lack of "specific pharmacological and non-pharmacological treatments" available (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 GPs (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 demonstrate 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.
Within the clinical context of dementia care, nutrition is a vitally important aspect that caregivers, doctors, and other healthcare providers must address with care. Writing in the peer-reviewed British Journal of Community Nursing, author Stephanie Ragdale explains that as people age they lose brain cells, requiring the best possible nutritional support. However, when a person develops dementia, the loss of brain cells is "catastrophic" (Ragdale, 2014). Thus, caregivers and professional healthcare providers must approach nutrition with great care and interest.
Ragdale, an Admiral Nurse in the United Kingdom, reports 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." Additionally, eggs and oily fish are both strong in Vitamin D, which is known to reduce the risk of dementia (Ragdale, S21).
This research is pertinent because everyday life for people with dementia is difficult to begin with. When the patient with dementia is undernourished or not eating properly, this can "increase confusion and irritability" in the individual. For caregivers, the patient's inconsistent "association with food" may be "frustrating and upsetting," leaving the caregiver "feeling helpless" because the struggle with proper eating can lead the caregiver to believe it is simply a sign of "the inevitable progress of the disease" (Ragdale, S22).
Eating problems are fairly common among people who suffer from dementia. A survey in the United States showed that over an 18-month period, 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 lose weight because of appetite loss, which can result from a diminished sense of smell and taste. It is therefore important for the caregiver to encourage good eating habits.
For dementia patients whose weight has fallen below normal levels, a fortified diet approach has proven effective. The caregiver can help a very thin dementia sufferer by providing "high-calorie ingredients" such as whole milk, cheese, butter, oil, yogurt, cream, and mayonnaise alongside regular meals (Ragdale, S24). Additionally, nutritious drinks such as smoothies, fresh fruit juices, and milky drinks can be beneficial. Research shows there is "strong evidence that oral nutritional supplementation" can increase weight, even if the dementia patient is unaware that extra calories are supplementing his or her regular diet (Ragdale, S24).
When a dementia patient experiences "excessive stimulation" in the caregiving environment, it can easily disrupt normal eating habits. Meal times should be consistent every day. Providing "clear visual and sensory cues" reduces the potential for disorientation in the dining area—meals should be attractive, smell good, and taste delicious to keep the patient interested in eating well (Ragdale, S24).
Ragdale also recommends not removing the ability of people with dementia 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 should be the watchword when helping dementia patients eat. Family caregivers must be "equipped with the knowledge and skills required" to provide appropriate nutritional support (Ragdale, S24).
Music therapy is an "attractive form of intervention" for dementia patients, and it is not merely theoretical—it is a proven practice, according to a peer-reviewed article in the Journal of Clinical Nursing. Music therapy is used in many situations involving "psychological, psychiatric and physical conditions," making it a reasonable intervention for patients suffering from dementia (Vasionyte, et al, 2013). Particularly when pharmacological interventions have not worked as expected or have led to "undesired side effects," music therapy can serve as a substitute. The authors of this article conducted a meta-analysis on the subject of music as therapy for dementia.
Using the keywords "music and dementia," the researchers accessed nineteen studies through databases, involving a total of 478 dementia patients. They determined through this meta-analysis that music interventions "seem to be effective" and have the potential of "increasing the quality of life" for those struggling with dementia (Vasionyte, 1203).
What exactly is a musical intervention for dementia? Vasionyte explains that a 1997 meta-analysis summarized 69 studies including "clinical empirical studies of music interventions, theoretical and philosophical papers," along with case studies and anecdotal accounts. That analysis found that music interventions improved "social, emotional and cognitive skills" and helped decrease "behavioral problems among demented people" (Vasionyte, 1204).
The author differententiates between "mere music listening" and "receptive versus active music therapy" provided by a trained therapist. Active music therapy involves "active involvement" by the participant—it is not simply playing pre-recorded music. Instead, participants in active music therapy may play instruments, sing along with music, dance to musical numbers, or engage in "song-drawing" (Vasionyte, 1204).
The therapist selects music based on the dementia patient's taste. Active music therapy is used for "arousal of positive emotions and increasing self-confidence." Ideally, music should be played live by the therapist or by a choral group from a nearby church or school, or by piano players on site playing live music that stimulates the patient. When music is played live, it "creates a stronger sense of reality," and the patient benefits from observing the musician or musicians and from singing along or humming (Vasionyte, 1204).
Who decides what music is most appropriate? The patient should be consulted, but relatives and caregivers can also be knowledgeable about what musical style would be most appropriate. Arousing positive memories can make this intervention effective. Another dimension is that groups sometimes benefit more from music therapy than individuals. The author suggests that group music therapy has been shown to be "more effective for improving social and socio-emotional skills of dementia patients" (Vasionyte, 1205).
The type of music selected is also important. If the music therapist wants the patient to quiet down and relax, semi-classical or relaxing music is appropriate. But if the goal is to arouse vivid memories, then folk songs from the patient's formative years or rock "oldies" would likely work best (Vasionyte, 1205).
Of the nineteen studies examined through meta-analysis, most reflected "large" positive outcomes on cognitive, behavioral, and physiological aspects, with "medium effects on affective measures" (Vasionyte, 1203).
An article in Geriatrics Gerontology International presents research into how caregivers in Mexico treating dementia patients are negatively impacted by their work. The authors, aware of the "accelerated growth of the elderly population" in Mexico and the increase of mental illnesses including dementia, carried out a study with six health-related institutions in Mexico City (Rosas-Carrasco, et al, 2014).
The caregiving experience can become "a heavy burden" especially when the older person has greater dependence on caregivers. The caregiver can become emotionally weary, struggle to sleep well, suffer from depression, and suffer from Dysexecutive syndrome, which includes problems with planning, abstract thinking, social flexibility, and control of one's behavior patterns (Rosas-Carrasco, 146).
Some behavioral disturbances associated with caregiving for dementia patients include "aggression, agitation, apathy, dysphoria and aberrant motor behavior" (Rosas-Carrasco, 147). Given these dynamics, the authors interviewed patients and caregivers at six general hospitals in Mexico between January 2007 and January 2010. Patients 60 years of age and older were included if they suffered from the following dementia types: Alzheimer's disease; vascular, mixed, frontotemporal, Lewy bodies, and Parkinson's-associated dementia. Participants needed to be able to read and write.
The research structure included eight assessment tools: (a) the Dysexecutive Questionnaire (DEX), a 20-item questionnaire using a Likert scale; (b) the "Mini-Mental State Examination," which determines the degree of cognitive impairment; (c) the Geriatric Depression Scale, a 15-item assessment of depression in older people; (d) the Barthel Index, a 10-item test measuring ability to carry out "independently the basic activities of daily living"; (e) the Lawton Scale, evaluating performance in daily living activities; (f) the Neuropsychiatric Inventory, a 12-item inventory validated for Spanish-speaking populations; (g) Patient comorbidities assessment; and (h) the Sleep Disturbances Inventory, an 8-item questionnaire measuring the quality of caregivers' sleep (Rosas-Carrasco, 148).
The results from the caregiver side of the research showed that most caregivers were women with a mean age of 57. Fifteen percent of caregivers were in dementia support groups. Most caregivers worked 6 days a week and over 8 hours a day, with 52 percent employed full-time (Rosas-Carrasco, 150). Interestingly, the higher the education level of the dementia patient, the greater the caregiver burden in Mexico—this might suggest that higher education leads dementia patients to argue, refuse medication, or otherwise become resistant.
The caregiver burden is greatly increased when one family member assumes full responsibility for caregiving. Personal needs are neglected, and the caregiver is unable to maintain another job for income. Caregivers demonstrated lack of "initiative," inability to "plan and organize," difficulty in communicating with those who are not demented, disturbed thinking processes, and increased burden when the dementia patient suffered sleep disorders (Rosas-Carrasco, 150).
An article in the journal Nursing Older People points to the success of animal-assisted therapy in helping and modifying behavioral and psychological symptoms of dementia patients. This research was based on the theory that when pharmacological treatments are not successful, a trained dog can be a worthy alternative to drugs. The 2014 article notes that according to the World Health Organization, approximately 36 million people in the world are known to have dementia, and "this number is expected to double every 20 years." Because the number of people with dementia is expected to grow substantially, positive interventions are necessary. Dogs are shown to be the most commonly used animals for such interventions (Nordgren, et al, 2014).
The authors conducted research using 33 residents with dementia in 8 nursing homes in Sweden. Twenty patients were placed in the intervention group and 13 in the control group. The Cohen-Mansfield Agitation Inventory (CMAI) and the Multi-Dimensional Dementia Assessment Scale (MDDAS) were used to evaluate the success of the dog-assisted interventions (Nordgren, 31).
Ten sessions were conducted with dogs—each session lasted between 45 and 60 minutes and took place twice weekly. The mere presence of a dog in a nursing home reduces "aggression and agitation in people with dementia" (Nordgren, 32). Dog-assisted interventions can increase "social interaction in people with dementia." The dogs used were a boxer, a golden retriever, and flat-coated retrievers (Nordgren, 33).
The dogs were all certified as trained in accordance with the Swedish Standards Institute. Immediately after each intervention session—involving the dementia patient's close interaction with the dog while the therapist guided the session—a "significant difference in psychological symptoms was observed between the [group being intervened with dogs] and the control group" (Nordgren, 35). The conclusion is that dog-assisted intervention may be a suitable alternative "or complement" to pharmacological treatments, although "further evaluation" is suggested by the authors.
What is the best method to encourage relatives with dementia to utilize social services? An article in the peer-reviewed Journal of Advanced Nursing reports on interviews with 16 family caregivers in Japan. As in other countries, the burden that caregivers carry is significant, with many caregivers suffering from depression and some experiencing burnout so severe that it has led to tragic outcomes including suicide and homicide (Takai, 2013). This research involved qualitative analysis of interviews with family caregivers, and several strategies were found to be successful in convincing dementia patients to use social services such as "adult daycare and short respite stays" (Takai, 2676).
The decision to use social services ultimately rests with the older Japanese family member. However, the qualitative analysis revealed the following strategies: (a) the caregiving adult was often found to be "yearning and searching" for the "least harmful service"; (b) the caregiver needed to "tailor the service to the older adult"; (c) persuading the older adult to use the service proved to be the toughest task; (d) "conforming the older adult to the service" was sometimes problematic; (e) "coercing the older adult to use the service"; (f) if the caregiver was feeling "desperation" and needed "respite," finding an appropriate social service became an urgent priority; and (g) the caregiver, regardless of burnout or desperation, always needed to "do what's best for the older adult" (Takai, 2675).
In conclusion, the idea of getting an impaired adult to adapt smoothly to a new environment, such as adult daycare, is sound but not an easy challenge. The research reflected in this paper demonstrates that there are a significant number of worthy theories and approaches for interventions. Music therapy and dog-assisted therapy are among the most intriguing options, and they all have value for both the caregiver and the patient. A comprehensive approach to dementia care that integrates behavioral management, nutritional support, professional interventions, caregiver relief, and community resources offers the best chance of improving outcomes and quality of life across the dementia care spectrum.
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