Question

what is meant by the devaluation of people with dementia in terms of their image and competence?

Answer 1

Dementia is not a disease but is a term describing a group of symptoms affecting memory and at least one other thinking skill such as concentration, language, judgement, sequencing, visuospatial skills, and orientation which interfere with daily functioning. Alzheimer’s disease is the most common form of dementia, although Lewy body dementia, Parkinson’s disease dementia, Vascular Dementia, and Frontotemporal Dementia are also encountered . While early in the disease course these different types of dementia can impair specific cognitive processes, such as memory, language, behavior, or executive functions, all types of dementia can impair decision-making. Impaired decision-making can have important consequences when considering medical capacity assessments or the legal determination of competency in patients suffering from dementia. As the number of patients with dementia is expected to rise in the next several decades , an understanding of how decision-making becomes impaired in patients with dementia is necessary.

Social Devaluation is a term that is generally used in cases where a society decides that certain individuals are worth less than others due to factors like race, sex, religion, class, money, etc. In that light dementia's do not devalue any individual, dementia comes for us all.You may need to address the social devaluation of people with dementia, through competency and image enhancement. Image is concerned with a person's sense of self and self-worth. Often the loss of independence and ability to communicate will erode a person's sense of self.

Competency is the legal determination of whether an impaired mental capacity limits a patient’s ability to make a legally relevant decision or action. Physician’s play an important role in this process: in most cases, capacity determinations are made in the clinic without adjudication, and even in cases that progress to legal hearings to determine competency, evidence from clinicians is often key. Importantly, capacity is context and decision-specific: a patient may retain the capacity for certain decisions, even if the capacity for other types of decisions is lost. Research has largely focused on the capacity for informed consent . In order to obtain informed consent, a patient must demonstrate four capacities: to understand the information presented, to appreciate how this information relates to their personal situation, to rationally use this information to arrive at a decision, and to maintain a consistent choice over time . Assessments tools for determining capacity for informed consent have been developed, utilizing structured interviews or by examining a patient’s ability to reason through hypothetical medical decision-making vignettes.

Image and competency enhancement increase the likelihood that people with disabilities will be not only accepted by others but fully incorporated into society. Citizen Advocacy challenges society's devaluation of people with disability.Finally, neuroimaging is currently of little added value beyond behavioral data in determining capacity and competency.The exception to this is that neuroimaging can improve the diagnostic certainty of specific types of dementia, which can be useful in determining a causal etiology for behavioral changes. It is unclear if neuroimaging will have further utility in such matters in the future.