Difficulties in Social and Occupational Activities

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Dementia is global concern in many countries. There are 35.6 million people worldwide andthis number is projected to be increase to over 115 million by 2050 and increasedprevalence is expected in developing countries where they have fastest growing oldpopulation (Alzheimer's Society, 2010a). Dementia is most commonly seen in people overthe 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 andoccupational 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 (Priceand Jackson, 2009). According to Poulschock & Deimling 1984, dementia associated burdenbetween the person with dementia and carer and family can be affected by physical orpsychological health of the carer. 40-75% of carers suffer from mental health problemswhich include major depression as 15-32% (Prince and Jackson, 2009). Dementia care isbased on the person centred care, in which person suffering from dementia is the core ofthe 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 socialisolation. Some people adapt to the ways that manages this illness, however, some peoplefeel angry and frustrated and lose their self- worth (Phinney, 2008 in chapter 2. excellenanein dementia). People reported that careful thought and attention is required to performactivities that had previously been easy (Imhof, 2003 P36 excellence in dementia). Difficultyto 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 ithard 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 inpeople with dementia (Aggarwal et al, 2003). These negative feelings can be directedtowards 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 whichinclude family members, friends and neighbours (Schulz & Martire, 2004). There is hugeimpact on families and communities as a consequences of dementia (Price and Jackson,2009). According to Poulschock & Deimling 1984, dementia associated burden between theperson with dementia and carer and family can be affected by physical or psychologicalhealth of the carer. 40-75% of carers suffer from mental health problems which includemajor 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'sillness and secondary stressors are related to the carer's other roles and activities that areaffected due to primary stressors (Aneshensel et al, 1995; Pearlin et al, 1190 pp 86excellence in dementia care). Impact of stressors on carer is influenced by meaning toevents, beliefs about ability to manage events and skills and resources they have (Zarit &Zarit, 2008 P86 excellence in dementia care). Depression, anxiety and other psychologicaldistress can be seen in carers when they are unable to cope with stressors looking afterpeople with dementia, and increased vulnerability to disease is related to chronic stress ofcarer (Vitaliano et al, 2003).Model of dementiaAn appropriate model of dementia is necessary to ensure interventions are plannedaccording to the individual needs.Medical Model of dementia- According to Medical model, dementia is assumed to be adisease caused by organic problems and should be treated and managed according to themedical authorities (Lyman, 1989).Social model of dementia- According to Social model, it is society's responsibility to provideappropriate 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 emphasizedthe importance of person centred care and personhood (Kitwood, 1993).Self- regulation model of adjustment to illness- This model emphasized the individualdifference in coping and responses of persons in relation to the illness (Clare, 2006).Biopsychosocial model of dementia- This model of dementia emphasized the identifyingfactors 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 reducebehavioural symptoms associated with dementia (A guide to psychosocial interventions inearly stages of dementia). Dementia is one of the disorders in older people that has socialstigma and cause increased dependency on others (Husband in ch 2 Moniz book). The social
stigma in dementia can be counteracted by development of timely psychosocialinterventions and support people with dementia since dementia is diagnosed (ch 3 inMoniz). Psychosocial interventions in dementia can be broadly classified as: support at thetime of diagnosis, interventions to enhance cognition and memory and interventions thatenhance psychological and social adjustment. These interventions can be used in personwith 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 inthe selection of psychosocial interventions (p. 24 in Moniz). Psychosocial interventions inearly dementia aim to reduce future disabilities. Handing out educational information andinformation on Alzheimer's Society for further information helps to involve person and thefamily, intensive communication methods are used to enhance positive attitude towardsperson suffering from dementia and the carer, standard psychological therapies such ascognition stimulation, behaviour therapy and psychotherapeutic group work helps to reducedistress in person with dementia and the carers, therapies that promote cognition and thatsupport psycho- social relationships helps to promote well being of person with dementiaand the carer (p. 21 in Moniz). Individuals sense of 'self' is compromised in dementia.Malignant social psychology associated with dementia is identified by person- centredapproach to dementia (p40 in Moniz).Person Centred CareIn 1940s, Carl Rogers introduced the idea of person centred care which recognized theindividual's unique values and personality (Laplege et al., 2007). The late professor, TimKitwood 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 neglectedpsychological, 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 ofage, cognitive ability and dependency level. (II) Treat people as individuals taking intoconsideration of unique history, personality and other factors that affect response to ageingand dependency. (III) Looking at the world from perspective of person needing care.(IV)Promote psychosocial environment which provides opportunities for personal growth. Allthese 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 forperson 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 thecontext of relationship and social being. It implies recognition, respect and trust.
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