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Difficulties in Social and Occupational Activities

Added on -2019-09-24

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Dementia is global concern in many countries. There are 35.6 million people worldwide and this number is projected to be increase to over 115 million by 2050 and increased prevalence is expected in developing countries where they have fastest growing old population (Alzheimer's Society, 2010a). Dementia is most commonly seen in people over the age of 65 years, however, it can also effect people in their early age (Peri & Cheung, 2016). Dementia is characterized by impairment in cognition and difficulties in social and occupational activities which results in difficulty to perform self care activities (Clare, 2007). There is huge impact on families and communities as a consequences of dementia (Price and Jackson, 2009). According to Poulschock & Deimling 1984, dementia associated burden between the person with dementia and carer and family can be affected by physical or psychological health of the carer. 40-75% of carers suffer from mental health problems which include major depression as 15-32% (Prince and Jackson, 2009). Dementia care is based on the person centred care, in which person suffering from dementia is the core of the cares and it values each person involved in the provision of cares (Loveday, 2013). Impact of dementia on person with dementiaPeople suffering from dementia have difficulties to perform everyday activities and social isolation. Some people adapt to the ways that manages this illness, however, some people feel angry and frustrated and lose their self- worth (Phinney, 2008 in chapter 2. excellenane in dementia). People reported that careful thought and attention is required to perform activities that had previously been easy (Imhof, 2003 P36 excellence in dementia). Difficulty to express feelings and follow along with communication can lead to social isolation (Clare, 2002 pp 37 excellence in dementia). Losing ability to drive and fear of getting lost makes it hard for people with dementia to get out in the world. Loss of social roles also leads to socialisolation (Phinney, 2008). Negative feelings such as anger and frustration is very common in people with dementia (Aggarwal et al, 2003). These negative feelings can be directed towards others (Beattie et al, 2004) or self directed and are described as 'inward anger' (Kutsuno, 2005). People with dementia are fearful about their future (Pearce et al, 2002). Lack of self- confidence and insecurity is very common in people with dementia (Phinney, 2008).Impact of dementia on carers and familiesIn community, Dementia people receive about 75-80% of community care by cares which include family members, friends and neighbours (Schulz & Martire, 2004). There is huge impact on families and communities as a consequences of dementia (Price and Jackson, 2009). According to Poulschock & Deimling 1984, dementia associated burden between the person with dementia and carer and family can be affected by physical or psychological health of the carer. 40-75% of carers suffer from mental health problems which include major depression as 15-32% (Prince and Jackson, 2009). Caregiver stressors are divided into
two main types: Primary stressors challenges that are directly related to their relative's illness and secondary stressors are related to the carer's other roles and activities that are affected due to primary stressors (Aneshensel et al, 1995; Pearlin et al, 1190 pp 86 excellence in dementia care). Impact of stressors on carer is influenced by meaning to events, beliefs about ability to manage events and skills and resources they have (Zarit & Zarit, 2008 P86 excellence in dementia care). Depression, anxiety and other psychological distress can be seen in carers when they are unable to cope with stressors looking after people with dementia, and increased vulnerability to disease is related to chronic stress of carer (Vitaliano et al, 2003).Model of dementiaAn appropriate model of dementia is necessary to ensure interventions are planned according to the individual needs.Medical Model of dementia- According to Medical model, dementia is assumed to be a disease caused by organic problems and should be treated and managed according to the medical authorities (Lyman, 1989).Social model of dementia- According to Social model, it is society's responsibility to provide appropriate social services and ensure disabled people's needs are fully taken into account (Oliver, 1999). Dialectical model of dementia- According to Dialectical model, dementia is the inter-relationship between neurological and social-psychological factors. This model emphasized the importance of person centred care and personhood (Kitwood, 1993).Self- regulation model of adjustment to illness- This model emphasized the individual difference in coping and responses of persons in relation to the illness (Clare, 2006).Biopsychosocial model of dementia- This model of dementia emphasized the identifying factors that may lead to either improvement or deterioration in the person (Spector & Orrell, 2010).Psychosocial interventionsPsychosocial interventions is the term used to describe the different ways to support peopleto overcome challenges and to maintain good mental health. There are various psychosocialinterventions that improve cognitive abilities, enhance emotional well being and reduce behavioural symptoms associated with dementia (A guide to psychosocial interventions in early stages of dementia). Dementia is one of the disorders in older people that has social stigma and cause increased dependency on others (Husband in ch 2 Moniz book). The social
stigma in dementia can be counteracted by development of timely psychosocial interventions and support people with dementia since dementia is diagnosed (ch 3 in Moniz). Psychosocial interventions in dementia can be broadly classified as: support at the time of diagnosis, interventions to enhance cognition and memory and interventions that enhance psychological and social adjustment. These interventions can be used in person with dementia or carer or with both. A focused assessment along with person's profile, interests and relationships for person with dementia and carer needs to be considered in the selection of psychosocial interventions (p. 24 in Moniz). Psychosocial interventions in early dementia aim to reduce future disabilities. Handing out educational information and information on Alzheimer's Society for further information helps to involve person and the family, intensive communication methods are used to enhance positive attitude towards person suffering from dementia and the carer, standard psychological therapies such as cognition stimulation, behaviour therapy and psychotherapeutic group work helps to reducedistress in person with dementia and the carers, therapies that promote cognition and that support psycho- social relationships helps to promote well being of person with dementia and the carer (p. 21 in Moniz). Individuals sense of 'self' is compromised in dementia. Malignant social psychology associated with dementia is identified by person- centred approach to dementia (p40 in Moniz).Person Centred CareIn 1940s, Carl Rogers introduced the idea of person centred care which recognized the individual's unique values and personality (Laplege et al., 2007). The late professor, Tim Kitwood provided a theoretical underpinning to person centred dementia care (Brooker, 2008). He emphasized the dementia care on the humanity of person rather than the diseaseand its associated deficits. According to Kitwood, medical model of dementia neglected psychological, social and spiritual aspects of person living with dementia (Downs, 2010 ch 25in supportive care for the person with dementia). There are four elements in person centreddementia care: (I) Value the person suffering from dementia and the carers regardless of age, cognitive ability and dependency level. (II) Treat people as individuals taking into consideration of unique history, personality and other factors that affect response to ageing and dependency. (III) Looking at the world from perspective of person needing care.(IV) Promote psychosocial environment which provides opportunities for personal growth. All these four elements provide basic framework to person centred care (Brooker, 2008). Personhood is the heart of person centred care (Hughes, 2001 p 8 in supportive care for person with dementia). Kitwood (1997a p 236 in pshychiatry book) defined personhood as:Personhood is a standing or status that is bestowed on one human being, by others, in the context of relationship and social being. It implies recognition, respect and trust.

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