Models of Care for the Elderly

INTRODUCTION:

The proper practice in care is not just about having to do things well or having the adequate knowledge, it also involves showing good moral and attitude towards people. The best way to determine that you have given out the suitable care is putting yourself in the other person’s shoe. The right way to social care is to always involve a good value base (Social Care Institute for Excellence, 2014).

In this paper, we are tasked to weigh the pros and drawbacks of the theories and principles that concerns the person- centred approach to care for people suffering with dementia and other health conditions for the elderlies.

The Task

Question 1

Person- centred approach

This type of approach directly addresses the person as a single and unique individual rather than looking through them generally or perhaps treating them straight with regards to their disease condition.

This method targets to care for the person with dementia as an individual with uniqueness, interests and needs rather than aiming to treat their illnesses or disabilities that they are currently suffering. Instead of focusing on their disease symptoms, this approach considers the person as a whole and is cared for holistically.

There are eight (8) approaches that cover this type of approach, the following are:

1. Individuality

Every person is unique from one another. A person suffering from dementia is stereo-typed as an individual who has lost his independence and conformity to society thus he is not handled as someone who still possess his own right to distinctiveness and dignity. It should be the case that people need to understand that these ones must be given value and respect as an individual despite having mental impairment. To be able to care for these clients, accurate and in- depth history of the client’s needs and preferences should be noted. These information should be sorted out well enough by the health care providers and handed over in a very precise manner to the caregivers so as to bring about the best care as what their loved ones have expected.

1. Rights

Although demented people have slowly diminished sense of personal identity, their personal rights have been gradually eroded too. However, even if these have occurred in them, their personal character, morals and values still retain. We can see that these people have lost their critical thinking, comprehension and judgment the reason why many of their rights have been violated and abused by the people around them. In order to protect the clients, especially those who are confined in aged care facilities, they always have the power of attorney.

The power of attorney is a written document that the client has given to another person to take charge or to represent in behalf of the client’s personal affairs and other legal matters against the wishes of the others (Citizens Advice Bureau NZ, 2014).

In order to give these people the care that they deserve, those who are included in the care must have an environment conducive for demented people, for them to be able to understand more of their sentiments, and interests. Also, an environment which is secure and safe because protection is always the priority for them.

1. Choice

Health care providers especially those ones who are involved directly with the care of people with dementia must not assume that they are not capable enough to make their own decisions. They should however, must be assisted in deciding with their daily preferences and needs. Good collaboration with them enhances their chance to regain independence and self- worth. To be able to create the plan of care to these clients, early detection of dementia is ideal for the healthcare providers to be able give them choices and plan out a comprehensive person- centred approach of care.

1. Privacy

This principle is very significant to every individual, in general. This should be uphold and encouraged. Issues pertaining to privacy and confidentiality must be dealt with accordingly, thus during staff meetings and inductions it should be emphasized that privacy and confidentiality of the clients must be maintained. Moreover, simple measures must be done especially in giving them their personal spaces and time. These simple approaches conceal huge impact to the clients daily living.

1. Independence

As dementia progresses, an individual’s capabilities of doing his own activities of daily living diminishes. It is not that they cannot carry out the activities anymore, it is just that they usually forget what they are supposed to do. The main reason why they need guidance and assistance most of the time and not imposing on them. When the caregivers enact things according to their wants just to get their work done in a fast manner, they are trying to take away the client’s freedom and independence.

1. Dignity

People with dementia should be handled with utmost respect. Always remember the person they used to be and dementia itself only should be the second of the priorities. In that way, when the healthcare providers use that awareness to make decisions about their care and their daily routine is one way of maintaining the patient’s dignity (A Place for Mom, 2015).

Always take into consideration that the person with dementia has no control of their judgment, memory and communication anymore. Therefore it is our duty to make modifications so as to help them direct their needs.

1. Respect

Dementia is seen as a slow deterioration of an individual’s personality until there is nothing left of that person and still, that person carries on. It is always a rule of thumb to maintain that much needed respect they need and in order to do so, staff should lessen embarrassment to the patient and focus on their optimistic attributes. Also, it is important to validate a person’s sense of self and self- worth (Victoria, 2014).

1. Autonomy

Clients suffering from dementia still has the capacity to make even small decisions. Although they are incapable of comprehending and deciding complicated tasks but still they deserve to be respected well.

A patient’s autonomy should be respected even if the client is against the health care provider’s recommendation. This has helped develop cooperation and collaboration in making health related decisions (University of Miami Ethics Program, 2015).

Question 2

Non- person- centred approach

This method is aimed in looking at the individual rather than viewing the person holistically. There are two perspectives in this approach, these are:

Institution perspective

This type of perspective is directed to the establishments and facilities which focus on the care of elderly patients. Such establishments are those retirement villages, rest homes, nursing homes.

The care plans made in this type of perspective are based on the institution’s policies and goals.

Bio Medical perspective

This perspective is based on the thought that human development is based on reason and rationality.

In this model, it is believed that science and technology can improve human health. There are six assumptions in this perspective. First and foremost, that mind and body can be cured independently. Second, the body is like a machine that when it breaks down it can still be repaired. Third, that medicine should develop a more advanced solution to the health problems. Fourth, biomedicine focuses on the biological aspect of the disease process not considering the psychological and social issues. Fifth, it is said that every disease has its own etiology and lastly, medicine is the only way through understanding the disease and illness process (Cantley, 2001).

Question 3

1. Reality- orientation approach

This method follows a view point of in- patient treatment for minimizing confusion in geriatric patients. In this philosophy, it is said that confusion comes from:

1. Under- stimulation of the patient.
2. Care providers’ absence of persuasion or anticipation that the client perform his normal behaviour.
3. Care givers’ no reinforcement of expected behaviours when the behaviours are performed (Taulbee and Folsom; Folsom, 1968).

1. Validation approach

This approach uses interaction of patients in the later stage of Alzheimer’s. This method aims to understand and feel for the needs of the person that he is trying to express. So, the concept of validation approach is the thought that people suffering with dementia say and reason out things with a purpose, and validating what they say and do is a way of boosting them to communicate openly and expressively with others (Pekker, 2011).

1. Reminiscence techniques

This technique includes the discussion of activities, events and experiences in the past with a group, usually with the help of noticeable and familiar things from the past. The participants, in this technique, are encouraged to express about past experiences at least once weekly. Also, there is also a life review that involves a one on one session in which the individual is led chronologically with his life experiences and encouraged to assess them and sometimes they may be able to make a life story book. This approach is said to be one of the used interventions in the care of patients with dementia and is highly rated by participants because it has evidently improved the mood and cognition of the clients.

1. Assistive technologies

This refers to any equipment, products or items used in helping to improve or maintain the capabilities of demented people most especially with their functional abilities, cognition and communication. This is beneficial to both parties, the carers and the demented client, as the job would be made easier and safer, easier and more person- centred.

1. Holistic approach

Clients with dementia may have benefitted from medication treatment, this approach believe that all individuals benefit from this type of method to care. There are four pillars in this approach, and these are:

• Environmental

There are environmental factors that triggers and enhances reactions and behaviours for the demented person. By accurately assessing these factors and eliminating those hazards, health care providers can reduce agitation, irritability, anxiety and maintain an environment conducive for living.

• Communication

It is important for caregivers in caring or dementia people to use effective communication methods because in this way reduction in agitation and frustration from the clients may result if and when you talk to them in a manner that is comforting. Dementia care communication can be verbal or non- verbal and knowing the difference impacts greatly as the demented individual can be affected either positively or negatively by words and body language.

• Nutritional

Giving the client the appropriate nutritional needs can affect your care to them. Foods rich in fibre supports digestive health and bowel movement, increase fluid intake can support hydration needs. Thus, it is evident that diet holds an important role in maintaining the old person’s well- being and health.

QUESTION 4

• PUBLIC HEALTH AND HEALTH PROMOTION

Demented people would require needed help and support in the long run especially when the illness has advanced to a higher level. They may not be able to express their thoughts and insights about their care. However, many organizations may it be publicly or privately- owned support them by providing good awareness and advocacy services. For example, for those clients who prefer to stay in their homes can still be supported through the elder care locator wherein they can freely choose the caregiver they want to care for them that lives nearby. Also, Alzheimer’s Association 24/7 Hotline where all questions by the client, loved ones, friends and family are being answered and explained to them in a way that can easily be understood. This can be accessed 24/7 at any time of the day. Lastly, the Alzheimer’s Association is another organization for those elderlies who wish to stay in a care facilities. This type of association gives a thorough explanation and choices of care facilities and its location that suits the elderly clients.

• ATTITUDES TO HEALTH AND DEMAND FOR HEALTHCARE

The young generation of today are surveyed to be afraid of aging and getting old most especially when they think about suffering from dementia because of the society’s stigma that they may face in the future. However, the aging process is inevitable and there is nothing that can be done to turn back time. Dementia is bound to be one of the add-ons when growing old and the young nurses these today are predestined to care for this aging population however, it will be a lot easier for them to do this because of the many organizations that support the Alzheimer’s community. They help and direct them towards the progress of the clients’ well- being and health. Therefore, it is right to give the elderlies with utmost respect and dignity regardless of race and condition.

References

A Place for Mom. (2015). Retrieved from http://www.aplaceformom.com/senior-care-resources/articles/dementia-dignity

Cantley, C. (2001). A Handbook of Dementia Care. Philadelphia, PA: Open University Press.

Net industries. (2015). Retrieved from Medicine encyclopedia: http://medicine.jrank.org/pages/1448/Reality-Orientation.html

Pekker, M. (2011, November 9th). Blogger corporation. Retrieved from Alzheimers review: http://alzheimers-review.blogspot.co.nz/2011/11/validation-approach-to-alzheimers.html

Victoria, S. o. (2014, July 16). Department of Health, State of Victoria Australia. Retrieved from http://www.health.vic.gov.au/dementia/changes/personal-identity.htm

Woods, B. S. (2005, April 18). PubMed. Retrieved from Cochrane Database Syst Rev: http://www.ncbi.nlm.nih.gov/pubmed/15846613