Approaches Towards Dementia Care

• Peter John Ignacio
• Jael Wafula

Support Planning for Geriatric Health Conditions

Introduction

Today, our society consists of increasing number of people aged sixty five and over. This is the result of the baby boomer effect in which post world war two children are now in the latter stages of their lives. It is believed that institutions which are inclined in supporting the elderly have to be experts in the health concerns that goes along with ageing. There can be a variety of health conditions an old person can have, these include, but not limited to, hypertension, diabetes, arthritis, osteoporosis, vision and hearing loss, skin changes, and mental, emotional and psychological changes. The latter, being the focus of this paper, is mostly referred to as the main concern of the elderly not only here in New Zealand but most of the elderly all over the world. Topics involving this will be examined in this paper, such as, the differentiation of person centred approach and non-person centred approach in care of the elderly, techniques in meeting the fluctuating abilities and needs of elder people with conditions in mentation, impacts of cultural diversity and impacts of health sector standards on the person-centred model of managing individuals with cognitive difficulties, like dementia of senior members of the community and other geriatric related health conditions.

Person-centred approach

First to be examined is the person centred approach which is focused on the elderly person, individual resident, if in a rest home setting; a particular patient, if in a hospital setting; or the senior citizens, in society as a whole. It is the principle of knowing the person being cared for, comprehensively, not only the health concern or the disease that they have. People even in the advance stages of their lives have the right to be treated with respect and dignity. To do this, it is paramount to know the person as who he or she is and how he or she would like to be treated. First and foremost is knowing the name of the patient, resident or any individual being cared for. This is the basic thing to know by heart and not to be undermined. It is easy to forget names at times but it is important to make sure to know and remember names of persons being cared for especially the elderly. This can be done by regularly checking the charts or records of clients and using their names when communicating with them on a daily basis. In turn, this can help in remembering and fully knowing the clients’ names and even furthering the caring relationship between the carers and the people being cared for. In addition to that, knowing clients’ personality and the activities they usually do would definitely help in establishing an outstanding relationship. Things like, hobbies, routines and favourites of the elderly are always good to know especially if they are residing in a facility that would benefit from these personal information for the continuity of care and to have harmonious client carer relationship altogether. In this way, satisfaction of elderly clients would be maintained and honoured. For elderly clients with dementia or similar health conditions, it is also indispensable to protect their rights. Western countries, New Zealand included, and other developed nations are very strict with regards to this. Clients, whatever their age is, should be treated and cared for in accordance to the bill of rights that everyone should respect and pay attention to, especially when caring for elderly clients. Included in this bill is the right of privacy. Privacy is still very important when caring for elderly clients. They are still fully aware of their surroundings and the things that make them uncomfortable should be avoided. The right of choice is also another factor that should be maintained in the life of the elderly. This means that clients have the right to choose of any aspect of their care. They are free to prefer being independent and to preserve their autonomy in everyday decision making, and of course the freedom from coercion or unconsented experiment or study that may be performed for the advancement of the geriatric medical field.

Non-person-centred approach

On the other hand, the non-person-centred approach to dementia and other advanced age related health concerns have a different precepts or premise. There are two common theme considered in the said approach. These are institution perspective and bio-medical perspective. The first one being focused in the welfare of the facility as the name implies. The reputation and the credibility of the institution is utmost important and to maintain a good image to the public, and perhaps to retain the funding provided by the government, institution perspective oriented facilities make sure that the elder clients are well taken care of. While the second one which is bio-medical perspective has its attention directed with the physical anomalies that elderly clients have. The main objective is to treat the disease and prolong life, which sometimes may overlook the most important factor in caring for the seniors, the getting to know part and truly addressing the needs of the clients not just the physical or bio-medical needs but the one that matters the most for clients of the said age group, the social and psychological aspect.

Techniques used to meet needs of individuals with dementia and common geriatric health conditions

To address further the needs and concerns of the senior citizens, there are some techniques used in various healthcare fields and facilities. The first to be discussed is the reality-orientation approach. This is about informing the clients of the current happening or event in the environment. For example, reorienting elderly of the time, date and place where they are at. This technique is very helpful in eliminating confusion and promoting clients’ confidence in performing activities for the day. In addition to the said events to be reoriented, familiar people and family members would facilitate better memory for the elderly. By seeing their relatives or hearing their names and stories about them, clients’ memory will be stimulated hence, vastly promotes confidence and lessen confusion and disorientation. Furthermore, the simplest but most important way to reorient clients is sometimes forgotten, this is using clients’ names always when communicating with them and informing them of activities they need to participate with for the day. For example, when entering a client’s room for his or her breakfast, a carer should knock on the door and politely call the client’s name to wake him or her up and encourage him to eat breakfast and to do succeeding client activities for the day. This will then make the client aware of his or her own surroundings and activities to be done. Therefore giving them confidence and feeling of self-worth.

The next technique which is gaining popularity is the validation approach, it is inclined with accepting the client, understanding and somehow putting one’s self into the shoes of the clients. By doing this, elderly clients will be more responsive to interventions, they will be more active in communication and therefore will be more happy and contented. By agreeing to them and not contradicting their understanding of things it will be easy for the carer to redirect and divert the attention of the elderly to the right path or correct thinking. Thus, frustrations that may lead to depression would be minimized or even eliminated.

Third technique is called assistive technologies. This is all about innovation and creativity being applied for not only practical but most importantly, for humanitarian cause. In this technique, modern equipment that can be used in everyday life are designed to promote independence, reduce risks and improve the quality of life of not only elderly clients but younger people with disabilities as well. Good examples of these technologies applied for the benefit of the elderly are clocks and calendars that have particular properties to prevent disorientation to time and date. Another are locator devices, these can be in a form of key ring or Velcro belts and bracelets that clients can wear and can be activated in cases of wandering and being lost. There is another type of elderly friendly technology that is very useful in ensuring safety and security for clients who are living by their own. This is called “Telecare”. It utilizes sensors that are installed around the client’s home and connected to a telecommunication device. This amazing technology detects environmental changes inside the house, such as, extreme temperatures, floods and even gas leaks. It also senses the client’s movements. For example, if the client is often getting up at night to go to the toilet or if there are risk of falls, this are detected by the sensors and appropriate communication will be submitted to the nominated person. These various forms of technologies prove to be very helpful in keeping the seniors safe and secure while maintaining their need to be independent and fully functional on their own (Alzheimer’s Society, 2015).

Forth to be examined is the reminiscence techniques. The premise of having psychotherapeutic measures that pertains to the life story of the elderly and how they lived their lives, focusing on the good and minimizing the regrets and resentments from previous events in the old persons’ lives. This approach is proven to improve clients’ mood. Cognitive ability and over-all well-being for clients with mild to moderate dementia. In some way it is inclined and similar to reality orientation approach in aspects of involving relatives and family members who are very close to the client and even those who played enormous roles in the life of the elderly in the past. This will lighten their days knowing that they still know and remember such important events and people. This in turn, will give empowerment, independence and autonomy in accomplishing everyday tasks, as aimed by other techniques of meeting senior client’s needs especially ones with dementia and similar cognitive difficulties (The Institute of Research and Innovation in Social Services, 2015).

Lastly among the techniques utilized for elderly clients, there is the holistic approach. This is mainly involved in simple things that comprises the totality of a client’s life. Included in this approach is the environment of the client. Basic things such as how furniture are arranged, proper lighting at home, reduction of clutters and other potential hazards to the elderly would vastly improve the way they live and can minimize or even eliminate accidents that most of the senior people dreaded. Sometimes this fear of mishaps may cause lack of confidence in doing activities on their own, hence, leading to sedentary life style. This then would have a negative impact on clients’ over-all health and may contribute in further deterioration of physical and psychosocial well-being. To alleviate this and supplement the environmental modification, it is invaluable for the carers to have effective communication with the elderly so that techniques of care will yield favourable outcomes. Communication can be in a verbal or non-verbal form. It should be assured that both modes of communication are comforting and not threatening to the elderly. The clients will be more compliant and will be more participative in care and activities if carers use proper, polite and effective communication. In addition to environment and communication, there is the aspect of nutrition and engagement to physical activities for the elderly clients. With older clients, nutrition and hydration is very important to maintain good health and avoid discomforts. For example, discomforts caused by difficulty in elimination or constipation. By providing clients with high fibre diet and encouraging them to increase fluid intake, the said discomfort can be significantly reduced. Finally, it is also a must to engage elderly clients in regular physical activities. Every morning exercises, brisk walking around the facility and simple games with balls and hoops can be of great help for the seniors in stretching their muscles and moving their joints. This will give clients time to spend to socialize with other clients, carers and their family, avoid boredom and minimise development of challenging behaviours.

Impacts of equality, culture and diversity on provision of person-centred approach

The most observable impact of culture, diversity and equality on person-centred approach of care seems to be positive in nature. Mostly positive in the sense that person-centred approach is all about caring for an individual. Having specific plan of treatment and care for a certain client. Applying individualize measures that would meet the specific needs of a certain individual based on culture is a very good example. While doing this, diversity and equality is being respected and recognized.

Impacts of health sector standards and code of practice and other published standards on person-centred practice approach

The health sector has established standards, policies and procedures that have made a huge impact on approaches and measures in managing health concerns of the elderly. The main code that affects person-centred approach is the well-known and widely accepted, Code of Health and Disability Services Consumers’ Rights. This is very good in promoting person-centred care because it emphasises on rights of clients not just the elderly but persons with disabilities and those who are vulnerable in the society. The code implies the respect in clients’ privacy, autonomy, dignity, right to fair treatment and appropriate standards of care, right to complete and accurate information and communication, right to support, rights during teaching and research and the right to complain. All of the said rights pertain to the individual and emphasises on respecting the individual as anyone would like to be respected. It is believed that this is the same premise of person-centred approach in one way or another (Health and Disability Commissioner, 2009).

Conclusion

After analysing various approaches and techniques in managing older people with dementia and other geriatric-related health conditions, such as, person-centred and non-person-centred approach, reality orientation, validation approach, assistive technologies, reminiscence techniques, holistic approach and impacts of equality, culture, diversity and effects of standards and codes of practice in the health sector, it is therefore concluded that people with advance age and are living with symptoms of dementia or age related health concerns benefit the most in care that is inclined in a person-centred type of health management. It is proven that elderly clients live better, maintain or even boost their confidence, retain autonomy or independence, preserve their dignity and have vast improvements in their over-all quality of life with the help of the said techniques and approaches to care which is centred to the seniors themselves.

References

Alzheimer’s Society. (2015). Assistive technology – devices to help with everyday living – Alzheimer’s Society. Retrieved from http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=109

Health and Disability Commissioner. (2009). Health and Disability Commissioner Code of Rights. Retrieved from http://www.hdc.org.nz

The Institute of Research and Innovation in Social Services. (2015). Supporting those with dementia: Reminiscence therapy and life story work IRISS Insights, no.4 | IRISS – The Institute for Research and Innovation in Social Services. Retrieved from http://www.iriss.org.uk/resources/supporting-those-dementia-reminiscence-therapy-and-life-story-work