Question

Dementia is a syndrome, usually of a chronic or progressive nature, in which there is deterioration in memory, thinking, behavior, and the ability to perform everyday activities. It mainly affects older people, although it is not a normal part of aging. There is currently no cure for dementia, but much can be done to support people with dementia and their caregivers. Describe an intervention that helps people with dementia and explain how this intervention addresses the problem.

Answer 1

Ans) Dementia is a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. Although dementia mainly affects older people, it is not a normal part of ageing. Worldwide, around 50 million people have dementia, and there are nearly 10 million new cases every year.

- Cognitive Stimulation Therapy (CST) is one form of non-pharmacological intervention used to support people with mild to moderate dementia. During CST, The person with dementia is invited to participate in therapeutic sessions with a trained practitioner, skilled in interpersonal communication and dementia care.

Reminiscence Therapy
A common symptom of dementia is impaired short-term memory, however, often the person’s long-term memory remains intact for some time. Reminiscence therapy is an intervention enabling a person with dementia tap into his/her long-term memory and re-live past usually pleasurable experiences. It is considered amongst the most popular of all non-pharmacological interventions and can be enjoyed by both people with dementia, their relatives and health service professionals. It can take many formats, including life story work, simple or general reminiscence, and specific or special reminiscence.

Life story reminiscence work enables people to reflect back over their lives, either individually or in a group, and subsequently a book or similar record of the individuals’ life is, with his or her permission developed. Simple or general reminiscence is usually aimed at sharing common memories, encouraging sociability, educational or recreational objectives. It usually uses open‐ended prompts or multi‐sensory triggers to stimulate reminiscence on topics likely to be of interest to participants and unlikely to trigger painful memories. Specific or special reminiscence is usually undertaken with individuals or small, closed membership groups. As the name suggests it is more specialized, more individualized and may have an element of life review or self-evaluation Involved. The setting in which Reminiscence is delivered should be safe, noise free and devoid of any other major interruptions. For some people, Reminiscence may improve quality of life, promote confidence, and boost self-esteem. Different cues are used in Reminiscence such as rummage boxes, the internet, SONAS, music, or photograph albums. Reminiscence can also take place simply through conversation, which serves to trigger former memories and emotions.  

Validation Therapy:
In validation therapy, the practitioner attempts to communicate with the person with dementia by empathising with his or her feelings and with the meanings behind that person’s speech and behaviour. (Douglas et al, 2004). Stated simply, validation therapy aims to legitimate the person’s emotions, by acknowledging feelings, even though the latter because of the dementia may be based on misinterpretations or misperceptions. The aim is to make the person with dementia as happy as possible. (Jones, 1997). Obviously when a person with dementia is having delusions (false beliefs), which cause distress, validation therapy would not be recommended.

Reality Orientation:
Reality Orientation helps the individual with dementia by reminding him/her about the present, by reinforcing self-identity, and by reminding that person of the surrounding environment. It can take many different forms including, cueing, signposts, calendars, notice boards, and often take place in groups or individually. In using Reality orientation, one must remain sensitive to the needs of the person with dementia, and keep in mind the fact that the person has a cognitive impairment and because of this may have difficulties remembering current events.

Physical Exercise:
Physical exercise has been shown to benefit people who do not have a cognitive impairment, but exercise is also beneficial for people with dementia, particularly those who once led a very active life. People with dementia should always be encouraged to participate in some form of physical activity, although obviously this will need to be adapted as the dementia progresses. In adapting exercise programmes attention should be given to the person’s abilities, interests, preferences and to safety needs. There is also evidence demonstrating how physical activity can reduce depressive symptoms and behavioural disturbances such as agitation, noisiness and aggression.

Multisensory Stimulation:

Multisensory stimulation in particular Snoezelen rooms are increasingly being used in long stay residential care settings to help people with dementia who may be restless or agitated. A Snoezelen room incorporates various aspects of multi sensory stimulation including fibre optics, light, water, colour, contrasting textures, soft furnishings, and quiet music. These features help to relax the person with dementia and can enhance communication between the person and his/her caregiver. Like many of the interventions discussed here, Snoezelen rooms are not appropriate for all people with dementia and research into the effectiveness of this intervention is limited.

Aromatherapy:
Aromatherapy is a complimentary therapy often used in dementia care. Through smells, massage and bathing, aromatherapy can evokes pleasurable emotions for the person with dementia. Two of the essential oils used in aromatherapy for people with dementia are extracted from lavender and melissa balm. Significant reductions in agitation have been demonstrated in recent control trials.